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 epigastrium on deep palpation. Laboratory investigations were within normal limits. The plain radiograph of abdomen 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 preoperative differentials were duodenal duplication and choledochal cyst.
At operation, a cyst medial to the gall bladder, pushing the stomach and the pancreas anteriorly and intimately 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 postoperative day. Histopathology of the specimen showed gastric mucosal lined tissue having smooth muscles in the wall along with ectopic pancreatic tissue (Fig. 4,5).