A 32-year-old man was seen in the emergency department after an episode of severe abdominal pain associated with bloating, nausea, and vomiting. The patient reported having no stool or gas for 1 week. He complained of intermittent abdominal pain over the previous 2 to 3 years but denied having any medical or surgical history, including pancreatitis. He did not recall sustaining any injuries.
On examination, his abdomen was mildly distended and he complained of moderate epigastric discomfort. His laboratory results were remarkable for dehydration. A computed tomographic scan was obtained (Figure 1). The patient subsequently underwent exploratory laparotomy after resuscitation without bowel preparation, given his proximal obstruction. The gross pathological specimen is shown in Figure 2.
Computed tomographic scan of the abdomen with oral and intravenous contrast demonstrating a cystic mass associated with the duodenum.
Photograph of the surgical specimen prior to resection demonstrating focal dilation of the duodenum with the cystic lesion.
A. Pancreatic pseudocyst
B. Traumatic intramuscular cyst of the duodenum
C. Duodenal duplication cyst
D. Echinococcal cyst
Spitzer AL, Mukhtar RA, Harris HW. Image of the Month—Quiz Case. Arch Surg. 2005;140(10):1005. doi:10.1001/archsurg.140.10.1005