Duodenal duplication cyst causing acute recurrent pancreatitis, managed curatively by endoscopic marsupialization.

Duodenal duplication cyst (DDC) is a rare congenital anomaly that typically presents with symptoms during childhood [1]. Acute pancreatitis and biliary obstruction have rarely been reported in adults [2,3]. Twomodalities of treatment havebeendescribed for DDCs: surgical [4,5] and endoscopic, by means of cyst marsupialization [1]. The rationale behind cyst marsupialization is to establish communication between the cyst cavity and the duodenal lumen so that the cystic contents can drain continuously into the duodenum [1]. We report a case of a 22-year-old man with a history of six episodes of acute recurrent pancreatitis (ARP) of unknown origin. Some of the episodes were severe and required hospitalization for 6–49 days. Magnetic retrograde cholangiopancreatography (MRCP) showed a regular cyst in the duodenal lumen, measuring 23×17mm, close to the major duodenal papilla (●" Fig.1). The lesion was erroneously diagnosed as a type III choledochal cyst and patient was referred to our institution for endoscopic sphincterotomy. We decided to perform duodenoscopy (●" Fig.2) and radial endoscopic ultrasound (●" Fig.3), which showed a bulging duodenal anechoic cyst with distinct walls, situated adjacent to the papilla at its anal margin. The cyst was covered by normal mucosa and measured 2.28×1.39cm, with an internal volume estimated at 2.6mL. Endoscopic retrograde cholangiopancreatography (ERCP) revealed normal findings, with no communication between the cyst and the pancreatic or common bile duct. A diagnosis of DDC was made and endoscopic treatment by means of cyst marsupialization was proposed. The procedure involved wide opening of the cyst wall with a needle-knife (Needle-knife Papillotome, Cook Medical, Bloomington, Indiana, USA), followed by Fig.1 Magnetic endoscopic retrograde cholangiopancreatography (MRCP) in a 22-year-old man with acute recurrent pancreatitis showing a regular cyst in the duodenal lumen, 23×17mm in size, close to the major duodenal papilla.