A 4-year-old male child came to the Emergency Room with a history of abdominal pain, fever and vomiting since 2 days. Clinical examination revealed tenderness in epigastrium, blood investigations revealed mildly raised serum amylase and elevated total leukocyte count child was sent for ultrasound to look for pancreatitis.
Ultrasound of abdomen revealed a well-defined thick-walled cystic lesion with internal echoes, debris and few calcific foci in its wall, in epigastrium extending to the right hypochondrium. (Figures 1, 3) Perilesional fat stranding and lymphadenopathy were also seen as suggestive of surrounding infection/inflammation (Figure 4) Lesion was in close approximation with second part(D2) of duodenum. (Figure 2)
Doppler revealed mild hyperemia of the cyst wall. The pancreas was normal in size and echotexture. Diagnosis of infected enteric (duodenal) duplication cyst was given.
CT abdomen with contrast was done later which revealed a 3.7 x 3.3 x 4.1 cm thick-walled peripherally enhancing retroperitoneal cyst along the wall of second part of duodenum with no luminal communication and surrounding fat stranding and lymph nodes, confirming the findings of ultrasound. (Figures 5,6) The pancreas was normal in size and attenuation on CT
Intra-operative findings: A common wall between cyst and D2 of duodenum was found with no communication between the two.
Enteric duplication cysts (EDCs) are rare congenital malformations formed during the embryonic development of the digestive tract, which can arise from any part of the digestive tract, from the mouth to the rectum . They are usually detected antenatally or during the first few years of life 
Most common location of EDCs is the mesenteric border of the ileum.
These are usually asymptomatic and complications are rare which include infection, bleeding, obstruction by volvulus or intussusception. 
EDCs must have three characteristics: an epithelial lining containing the mucosa of the alimentary tract, an envelope of smooth muscle, and the cyst must be closely attached to adjacent digestive tract by a common wall. 
These lesions can be cystic or tubular and often show the same structure as of the adjacent normal bowel (“gut signature”) or the double wall sign, however this sign may not always be seen.
Most duplication cysts do not communicate with the intestinal lumen. Duodenal duplication cysts are very uncommon and represent only 2 to 12 % of all digestive tract duplications. Most of them are located on second or third part of duodenum and share muscle layers.
Duodenal duplication cysts can lead to pancreatitis, possibly related to compression of pancreatic duct.
Enteric duplication cyst should be kept as an imaging differential for a cystic lesion in approximation with a bowel loop. Ultrasound is the investigation of choice for its diagnosis. CT or MRI may be done in case of any associated complication
Written informed consent for publication has been obtained from patient’s mother.
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 Di Serafino M, Mercogliano C, Vallone G. Ultrasound evaluation of the enteric duplication cyst: the gut signature. J Ultrasound. 2015 Nov 23;19(2):131-3. doi: 10.1007/s40477-015-0188-8. (PMID: 27298642)
 Torres Diez E, Pellón Dabén R, Crespo Del Pozo J, González Sánchez FJ. Imaging Findings of Duodenal Duplication Cyst Complicated with Duodenal Intussusception and Biliary Dilatation. Case Rep Radiol. 2016;2016:3069576. doi: 10.1155/2016/3069576. Epub 2016 Feb 17. (PMID: 26989550)
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