Duodenal Duplication Cyst having Ectopic Gastric and Pancreatic Tissues

A 1-year-old female child presented with distention of abdomen, accompanied with occasional episodes of vomiting and abdominal pain for the past eight months with no history of constipation or fever. The child was vitally stable. On inspection upper abdomen was found distended and mild tenderness in epigas-trium on deep palpation. Laboratory investigations were within normal limits. The plain radiograph of ab-domen was unremarkable. Ultrasound scan showed a 6.9 cm x 7.5 cm sized cystic area with internal debris at porta hepatis, compressing the liver. CT scan showed a 5 cm x 7 cm sized cyst extending from porta hepatis to the duodenum (Fig. 1). The preopera-tive differentials were duodenal duplication and choledochal cyst. Figure 1: CT scan showing a hypo-dense area at porta hepatis. At operation, a cyst medial to the gall bladder, push-ing the stomach and the pancreas anteriorly and inti-mately related to the second part of the duodenum was found (Fig. 2).The content of the cyst was clear mucous on aspiration. Intra-operative cystogram was performed that ruled out its communication with biliary and alimentary tracts (Fig. 3). The wall of the cyst was opened and stripping of mucosal lining performed after excising resectable portion of the cyst. The cyst was sharing common wall with duodenum and was non- communicating. The child made an uneventful recovery and was discharged on the fifth postopera-tive day. Histopathology of the specimen showed gas-tric mucosal lined tissue having smooth muscles in the wall along with ectopic pancreatic tissue (Fig