Hyperamylasemia, duodenal duplication, and pleural effusions in hereditary spherocytosis

Relapsing pancreatitis due to juxta-pancreatic duodenal duplication cyst with pancreatic ductal communication

A 21 year old patient first presented with acute pancreatitis in infancy, followed by subsequent episodes of relapsing pancreatitis in childhood. The cause of the pancreatitis defied diagnosis, despite two laparotomies in infancy and childhood, until twenty years later when a juxta-pancreatic duodenal duplication--a rare congenital lesion--was finally discovered. The duplication communicated with the main pancreatic duct via a long, aberrant duct, resulting in the relapsing pancreatitis. Abdominal ultrasonography and computerized tomography scan, and endoscopic retrograde cholangiopancreaticogram were useful in demonstrating the lesion. Surgical excision of part of the cyst, with marsupialization of the remaining structure to the stomach, abolished further symptoms and recurrence of pancreatitis.

A duodenal duplication cyst communicated with an accessory pancreatic duct

We treated a 49 year-old woman with acute pancreatitis, in whom there was an accessory pancreatic duct which opened into a duodenal duplication cyst. Epigastric pain associated with vomiting and fever were present. Laboratory data showed leukocytosis and hyperamylasemia. An upper G-I series revealed a stricture at the pyloric region. At operation a spherical mass of 6 cm in diameter was present between the greater curvature of the pyloric region and the head of the pancreas. The cyst was removed by hemigastrectomy and partial resection of the head of the pancreas. The accessory pancreatic duct opened into the cyst. Taking particular note of the communication with the pancreatic duct, this cyst was diagnosed as one of duodenal duplication. A duodenal duplication cyst communicating with the accessory pancreatic duct is rare and is dissimilar to any of the 20 cases of duodenal duplication reported in Japan since 1960.