ENTERIC DUPLICATIONS OF THE PANCREATIC HEAD - DEFINITIVE MANAGEMENT BY LOCAL RESECTION

Background/Purpose: Enteric duplications can occur throughout the enti re alimentary tract. When they occur in the pancreatic head, they pres ent a formidable challenge in both diagnosis and treatment. Surgical m anagement has ranged from simple drainage to local excision or radical resection leg, Whipple procedure). The authors propose that with iden tification of the local anatomic relationships, definitive management can be achieved by complete local resection of the cyst mucosa. Method s: The authors have treated four patients, ages 13 months to 4 years f or enteric duplication cysts within the pancreatic head. Results: Clin ical presentations were quite varied, including pancreatitis (n = 2), gastritis (secondary to increased production of gastrin), and recurren t pleural effusion with high amy[ase content. Two of the four cysts ha d been drained initially using Roux-en-Y cystenterostomies. Our preope rative imaging studies included abdominal ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), angiography, computerized tomography (CT) or magnetic resonance imaging (MRI) scanning. When nec essary intraoperatively, ultrasonography was used for cyst localizatio n and transduodenal pancreatography to define precise ductal relations hips. All four duplication cysts were completely excised, including tw o that communicated directly with the main pancreatic duct. One of the latter extended into the pleural cavity and required a thoracotomy fo r complete excision. Pathological exam of the excised cysts demonstrat ed gastric, duodenal, or respiratory mucosa. All four patients have re mained entirely asymptomatic during a follow-up of 2 to 7 years postop eratively. Conclusion: The authors conclude that complete local resect ion of enteric duplication cysts in the pancreatic head can be perform ed for definitive management, avoiding the complications of more radic al procedures. J Pediatr Surg 33:1117-1121. Copyright (C) 1998 by W.B. Saunders Company.