Endoscopy 2022; 54(11): E610-E611
DOI: 10.1055/a-1722-2250
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An unusual cause of abdominal obstruction in a 10-year-old boy successfully treated by endoscopy

1   Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
,
2   Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Guillaume Rossignol
3   Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
4   Unité Inserm 1052, Centre de Recherche en Cancérologie de Lyon
,
Sophie Heissat
5   Hépatologie gastroentérologie et nutrition pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
,
Remi Dubois
3   Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
,
Jérôme Rivory
2   Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Mathieu Pioche
2   Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
› Author Affiliations
 

Duodenal duplication cysts are congenital anomalies caused by embryonic malformations. They are extremely rare and account for only 4 % of all gastrointestinal (GI) tract duplications. Symptoms mainly occur during the first decade of life [1].

We report here the case of a 10-year-old boy who developed upper GI obstruction caused by a major acute bleed within a duodenal duplication cyst ([Fig. 1]). He was initially treated with upper GI aspiration with a nasogastric tube.

Zoom Image
Fig. 1 Computed tomography image showing a duodenal duplication cyst in a 10-year-old boy.

After a multidisciplinary discussion, we decided to perform an endoscopic marsupialization of the cyst to treat the obstruction and assist with the forthcoming surgery ([Video 1]). After the cyst had been located during an initial upper GI endoscopy, an endoscopic ultrasound (EUS) was performed to clarify the situation. The cyst was found to be 7.4 × 4.4 cm and had both solid and liquid components ([Fig. 2]). It was punctured to confirm the recent bleeding and to enable a guidewire to be placed inside, thereby facilitating the rest of the procedure by making the entry point visible despite the recent bleeding. A colonoscope with a hood was then used to create a large incision on top of the cyst using a DualKnife (Olympus) and following the guidewire. After the inside of the cyst had been penetrated and the liquid component sucked out, a snare was used to remove the remaining clots. The mucosal layer was present only at the bottom of the cyst; only the typical muscular layer was present elsewhere ([Fig. 3]). Coagulation of small bleeding spots was performed with hot biopsy forceps and a double-pigtail stent was placed inside the cyst as there were remaining clots inside. The patient was able to eat the day following the procedure.

Video 1 An unusual cause of abdominal obstruction in a 10-year-old boy successfully treated by endoscopy.


Quality:
Zoom Image
Fig. 2 Endoscopic ultrasound image of the duodenal duplication cyst.
Zoom Image
Fig. 3 Endoscopic images showing: a a guidewire inside the duodenal duplication cyst, with the muscular layer visible behind; b the inside of the duodenal duplication cyst, with the muscular layer, mucosa, and remaining blood clots visible.

To our knowledge, this is one of the first case reports showing endoscopic marsupialization of a hematic duodenal duplication cyst [2]. This technique was effective and safe and allowed risky emergency surgery to be avoided.

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Lucile Héroin, MD
Gastroenterology and Hepatology Unit
Hôpitaux Universitaires de Strasbourg
1 quai Louis Pasteur
67000 Strasbourg
France   

Publication History

Article published online:
26 January 2022

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Zoom Image
Fig. 1 Computed tomography image showing a duodenal duplication cyst in a 10-year-old boy.
Zoom Image
Fig. 2 Endoscopic ultrasound image of the duodenal duplication cyst.
Zoom Image
Fig. 3 Endoscopic images showing: a a guidewire inside the duodenal duplication cyst, with the muscular layer visible behind; b the inside of the duodenal duplication cyst, with the muscular layer, mucosa, and remaining blood clots visible.