Alimentary tract duplications are rare congenital anomalies. The duplications are named after the part of alimentary tract, to which these are intimately attached. Few cases of alimentary tract duplications may contain ectopic mucosa and pancreatic tissue . Most of the alimentary tract duplications are cystic and non-communicating. Pyloroduodenal duplications are mostly non-communicating [1,2] as in our case; however a case of communicating pyloroduodenal duplication has also been reported .
Pyloroduodenal duplications present with symptoms of gastric outlet obstruction and abdominal mass. Similarly, our patient presented with abdominal mass and occasional emesis. The alimentary tract duplications, in this location, can mimic other cystic lesions like mesenteric cyst, pseudopancreatic cyst, and choledochal cyst etc. Plain abdominal radiograph may show a mass effect in the epigastrium surrounded by displaced gas shadows. Ultrasound, contrast study, endoscopy, and CT scan are important diagnostic tools. Thick wall of the cyst as appreciated on the CT scan, can give a clue of duplication cyst as wall enhancement is not featured by the most of other cystic lesions in the vicinity [1-3].
The Pyloroduodenal duplication has been managed by complete excision of the duplication with pyloroduodenal enterectomy and end to end pyloroduodenal anastomosis , or by excision of the free part of the duplication cyst along with mucosal stripping of the remaining portion which is intimately attached to the pyloro-duodenum . The second approach was considered safe and was used in the index to which she responded well.