Diagnostics and surgical management of periampullary duodenal duplication cysts in children: a report of cases

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Abstract

BACKGROUND: Obstructive variants of chronic duodenal obstruction may be caused by congenital malformations, such as rare periampullary duodenal duplication cysts. This localization of gastrointestinal duplications is the rarest and is not described in the domestic literature.

AIM: This study aimed to present the experience of the management of periampullary duodenal duplication cysts in children.

CASES REPORT: Seven children with periampullary duodenal duplication cysts underwent surgery between 2007 and 2022. All patients suffered from prolonged abdominal pain, vomiting of food, and bile. Two children had recurrent pancreatitis, and one child underwent repeated operations for high intestinal obstruction and biliary obstruction in other hospitals. An abdominal cyst was suspected in one patient at another hospital, and the child underwent exploratory laparoscopy, but no formation was found. Ultrasound, gastroduodenoscopy, computed tomography, and magnetic resonance imaging were performed on these children. Ultrasound examination showed a peristaltic cystic formation up to 4 cm in diameter with a double wall. Gastroduodenoscopy showed formation in the second portion of the duodenum in the region of the major duodenal papilla. This formation covers the intestinal lumen by two-thirds and up to nearly complete obturation. The relationship between duodenal duplication and the bile and pancreatic ducts was clarified on magnetic resonance cholangiopancreatography: the relationship was suspected in two children. All patients underwent wide transduodenal excision of periampullary duodenal duplication cyst; in four cases, laparoscopic access was used. No intra- and postoperative complications occurred. Histological examination revealed true duplications in all cases. The children were discharged on days 11–12. In the follow-up after 3 months and 10 years, no complications were noted.

CONCLUSIONS: Periampullary duodenal duplication cysts can be a cause of chronic duodenal obstruction. Transduodenal excision of periampullary duodenal duplication cysts is the optimal treatment, and this operation can be performed laparoscopically.

About the authors

Yurii Yu. Sokolov

Russian Medical Academy of Continuous Professional Education

Email: sokolov-surg@yandex.ru
ORCID iD: 0000-0003-3831-768X
SPIN-code: 9674-1049

MD, Dr. Sci. (Med.), professor, head of the Department of pediatric surgery

Russian Federation, Moscow

Grachik T. Tumanyan

Russian Medical Academy of Continuous Professional Education

Email: tumanyan@list.ru
ORCID iD: 0000-0002-5554-4203

MD, Dr. Sci. (Med.), professor of the Department of pediatric surgery

Russian Federation, Moscow

Artem M. Efremenkov

Russian Medical Academy of Continuous Professional Education

Email: efremart@yandex.ru
ORCID iD: 0000-0002-5394-0165
SPIN-code: 6873-6732

Cand. Sci. (Med.), assistant professor of the Department of pediatric surgery

Russian Federation, Moscow

Zhanna R. Omarova

Pirogov Russian National Research Medical University

Email: ganu82@mail.ru
ORCID iD: 0000-0001-9035-0511
SPIN-code: 2579-5929

assistant of the Department of pathological anatomy and clinical pathological anatomy of the pediatric faculty

Russian Federation, Moscow

Oleg Yu. Koshurnikov

Regional Children’s Hospital

Email: okosh@mail.ru
ORCID iD: 0000-0003-4292-7835

head of the Department of surgery No. 1

Russian Federation, Yekaterinburg

Alaniia A. Gogichaeva

Russian Medical Academy of Continuous Professional Education; St. Vladimir Children’s Hospital

Author for correspondence.
Email: gogichalani@gmail.com
ORCID iD: 0000-0003-3614-6493
SPIN-code: 2124-5942

postgraduate student of the Department of pediatric surgery

Russian Federation, Moscow; Moscow

References

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Supplementary files

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2. Fig. 1. Ultrasound picture of a cystic formation with pathognomonic for enterocysts “double-wall sign” of patient 2

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3. Fig. 2. Computed tomography of patient 5. The arrow points to the cystic formation in the lumen of the duodenum

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4. Fig. 3. Magnetic resonance cholangiopancreatography of patient 5. No reliable connection was found between cystic formation with the bile ducts

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5. Fig. 4. Periampullary duodenal duplication cyst of patient 1

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6. Fig. 5. Excision of the walls of the periampullary duodenal duplication cyst of patient 3

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