Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1182-1188
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1182
Gastric duplication cyst communicating to accessory pancreatic lobe: A case report and review of the literature
Michael Rousek, David Kachlik, Andrej Nikov, Jirina Pintova, Miroslav Ryska
Michael Rousek, Andrej Nikov, Miroslav Ryska, Department of Surgery, 2nd Faculty of Medicine, Charles University and Central Military Hospital, Prague 16002, Czech Republic
David Kachlik, Department of Anatomy, 2nd Faculty of Medicine, Charles University, Prague 15006, Czech Republic
Jirina Pintova, Department of Gastroenterology, Jablonec nad Nisou Hospital, Jablonec nad Nisou 466 01, Czech Republic
Author contributions: Rousek M and Ryska M performed a surgery and designed the report; Rousek M collected the patient’s clinical data; Pintova J investigated a patient; Rousek M, Kachlik D, Nikov A, Pintova J and Ryska M wrote the paper.
Supported by Czech Ministry of Defence, Project MO 1012.
Informed consent statement: The patient provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Miroslav Ryska, MD, PhD, Professor, Department of Surgery, 2nd Faculty of Medicine, Charles University and Central Military Hospital, U Vojenske Nemocnice 1200, Prague 16000, Czech Republic. miroslav.ryska@uvn.cz
Telephone: +420-973-202901 Fax: +420-973-202898
Received: August 17, 2018
Peer-review started: August 17, 2018
First decision: October 5, 2018
Revised: November 7, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 26, 2018
Processing time: 129 Days and 4.7 Hours
Abstract
BACKGROUND

The combination of a gastric duplication cyst and duplicated part of the pancreas is an extremely rare developmental defect. The incidence in the population, or the clinical impact thereof, has not been uncovered. Symptoms are unspecific. Surgery is the treatment of choice. Timely diagnostics are of utmost importance, albeit they might be challenging at times. Being so rare, case reports are currently the only relevant source of information about the condition. Therefore each published finding is of a clinical impact.

CASE SUMMARY

Our work describes the case of a 22 year-old patient, who developed idiopathic acute pancreatitis. A computed tomography scan discovered liquid collection between the antrum of the stomach and the head of the pancreas. Initially, the collection was thought to be a pancreatic pseudocyst. Endoscopic ultrasound-guided transgastric drainage showed to have only a temporary therapeutic effect. Magnetic resonance cholangiopancreatography showed an accessory pancreatic lobe with a separate duct system. The accessory pancreatic lobe exited the body of the pancreas and was in contact with the cystic collection. The patient was indicated for surgical resection. Within the surgery, an en bloc resection of the accessory pancreatic lobe was performed with the antrum of the stomach containing the gastric duplication cyst. No complications were observed in the surgery or thereafter. In the five months follow-up period, the patient was completely symptom free. Histopathological findings confirmed the gastric duplication cyst communicating to accessory pancreatic lobe.

CONCLUSION

This developmental defect is extremely rare. It can cause recurrent acute pancreatitis. Diagnostics are challenging. Surgery is treatment of choice.

Keywords: Pancreatic resection; Accessory pancreatic lobe; Acute pancreatitis; Developmental defect; Gastric duplication cyst; Case report

Core tip: The combination of gastric duplication cyst and pancreatic duplications is an extremely rare developmental defect that can cause serious health problems in patients, including attacks of recurrent acute pancreatitis. Surgery is the treatment of choice, leading to complete resolution of symptoms in all published cases. Our paper summarizes the available information on this rare developmental defect, with a focus on potential for timely diagnostics and optimum treatment strategy. We also suggest unification of until now non-uniform anatomical nomenclature and we present a current knowledge of embryogenesis. We believe this information can help physicians in treatment of similar cases in future.