Pacifique Joseph Xavier, Jauquier Nicolas, Divjak Natalie, Godat Sebastien, Vasseur Maurer Sabine
Department of Surgery, Etablissement Hospitalier du Nord Vaudois eHnv, Yverdon-les-Bains, Switzerland.
Department of Pediatric Surgery, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.
Front Pediatr. 2025 Jun 26;13:1588823. doi: 10.3389/fped.2025.1588823. eCollection 2025.
Duodenal duplication cysts (DDC) are rare congenital malformations which are generally diagnosed in the first decade of life. The clinical presentation of DDC is highly variable and may be complicated by pancreatitis. When pancreatic pseudocysts (PPC) develop, definitive DDC treatment is delayed and exposes the patient to recurrent episodes of pancreatitis which further lengthen the process. We present a novel approach to the management of such cases by using echo-endoscopic cystogastric drainage of a large retrogastric PPC as a bridge to surgery. To our knowledge, this is the youngest reported case.
A 21-month-old girl presented with abdominal pain, bloating, vomiting and failure to thrive lasting for 3 months. Her prior medical history was normal.
Blood work showed pancreatitis. Ultrasound (US) showed multiple cysts inside the abdomen. A thoraco-abdominal magnetic resonance imaging (MRI) scan allowed differentiation between multiple PPC and a DDC, which had caused a complicated obstructive pancreatitis. The DDC was confirmed by biopsies. Further imaging identified a large persistent retrogastric pseudocyst. Due to poor feeding and stable but compromised general condition, a two-step procedure was scheduled with echo-endoscopic cystogastric drainage of the large retrogastric PPC to reduce the convalescence time after the last episode of pancreatitis, followed by surgical resection of the DDC. The patient was released from the hospital the day after this procedure as oral intake had normalized. Unfortunately, 3 weeks after this procedure, the patient developed a septic shock due to infection of the remaining cysts. As surgery was required to treat the sepsis, the DDC was resected at the same time.
Echo-endoscopic cystogastric drainage is feasible and effective in children as young as 21 months. Pediatric guidelines have yet to be determined for this procedure.
十二指肠重复囊肿（DDC）是罕见的先天性畸形，通常在生命的第一个十年被诊断出来。DDC的临床表现高度多变，可能并发胰腺炎。当胰腺假性囊肿（PPC）形成时，DDC的确定性治疗会延迟，使患者遭受胰腺炎的反复发作，这进一步延长了病程。我们提出一种新的方法来处理此类病例，即使用超声内镜下对巨大胃后PPC进行囊肿胃引流作为手术的桥梁。据我们所知，这是报道的最年轻病例。
一名21个月大的女孩出现腹痛、腹胀、呕吐和发育不良，持续3个月。她既往病史正常。
诊断、治疗干预及结果：血液检查显示有胰腺炎。超声（US）显示腹部有多个囊肿。胸腹磁共振成像（MRI）扫描能够区分多个PPC和一个导致复杂性梗阻性胰腺炎的DDC。通过活检确诊为DDC。进一步成像发现一个巨大的持续性胃后假性囊肿。由于喂养困难且一般状况稳定但受损，计划采用两步法，先通过超声内镜对巨大胃后PPC进行囊肿胃引流，以缩短最后一次胰腺炎发作后的康复时间，然后手术切除DDC。该操作后第二天患者出院，因为口服摄入量已恢复正常。不幸的是，该操作3周后，患者因剩余囊肿感染发生感染性休克。由于需要手术治疗败血症，同时切除了DDC。
超声内镜下囊肿胃引流对于21个月大的儿童是可行且有效的。该操作的儿科指南尚未确定。
