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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 7

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 7

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Four day old full term male with vomiting and a palpable abdominal mass.

Clinical History:
This patient was a 4 day old full term male with non-bilious vomiting since birth and an abdominal mass which could be palpated near the umbilicus.

Clinical Physical Exam:
A relatively mobile, non tender, round 4 cm mass was palpable in the mid abdomen.

Clinical Labs:

Clinical Differential Diagnosis:
GI duplication cyst

Imaging Findings:
Abdominal films from the fourth day of life revealed a midline abdominal mass. An abdominal ultrasound exam from the next day revealed a complex cystic mass in the mid abdomen.

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Imaging Differential Diagnosis:
GI duplication cyst with internal hemorrhage, teratoma, pedunculated cystic hemangioma of liver.

Operative Findings:
On the sixth day of life, through a supraumbilical transverse incision, the abdomen was explored to further characterize the mass. The mass was seen to be a cystic enteric duplication of the proximal duodenum, attached to the inner surface of the C-loop of the duodenum from just distal to the pylorus to slightly proximal to the region of the ampulla of Vater. The duodenum and its associated mass were resected. The distal antrum and the second portion of the duodenum were then anastomosed in a Billroth I - type gastroduodenostomy.

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Pathological Findings:
Examination of the surgical specimen revealed the characteristic findings of an enteric duplication cyst within the wall of gastric antrum and proximal duodenum with an associated small nodule of ectopic pancreatic tissue.

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Final Diagnosis:
Duodenal Duplication

Follow-up and Prognosis:
The patient developed a small bowel obstruction 1 month post operatively, for which he had an exploratory laparotomy with lysis of adhesions. The patient has since done well

Similar Cases:
Case 32


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