EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas:A case report

Cystic dystrophy of the duodenal wall is a rare conditioncharacterized by the development of cysts in heterotopicpancreatic tissue localized in the duodenal wall.A 38-year-old man was admitted to the hospital for abdominal painand vomiting after food intake.The diagnosis of acutepancreatitis was initially suspected.Abdominal ultrasoundexamination revealed thickening of the second portion ofduodenal wall within which,small cysts(diameter,lessthan 1 cm)were present in the vicinity of pancreatic head.The head of pancreas appeared enlarged(63 mm×42 mm)and hypoechoic.Upper endoscopy and barium X-ray serieswere performed revealing a severe circumferentialdeformation,as well as 4 cm long stenosis of the secondportion of the duodenum.CT examination revealed multiplecysts located in an enlarged,thickened duodenal wall withmoderate to strong post-contrast enhancement.Wesuspected that patient had cystic dystrophy of duodenalwall developed in the heterotopic pancreas and diagnosiswas confirmed by endoscopic ultrasound(EUS).Endoscopicultrasound(EUS)revealed circular stenosis from the duodenalbulb onwards.A twenty megahertz mini-prope examinationfurther showed diffuse(intramural)infiltration of duodenalwall limited to the submucosa and muscularis propria of thesecond portion of duodenum with multiple microcysts withinthe thickened mucosa and submucosa.Patient was successfullysurgically treated and pancreatoduodenectomy wasperformed.The pathological examination confirmed adiagnosis of cystic dystrophy of a heterotopic pancreas.Endoscopic ultrasonography features allow preoperativediagnosis of cystic dystrophy of a heterotopic pancreas induodenal wall,with intralumina120 MHz mini probe sonographybeing more efficient in cases of luminal stenosis.