Hypertrophic pyloric stenosis and gastric duplication containing pancreatic tissue: a case report

Introduction: Hypertrophic pyloric stenosis (HPS) and gastric duplication (GD) cysts are well-known surgical conditions in pediatric patients. However, only a few cases of HPS associated with alimentary tract duplications have been reported in the literature. Case presentation: A three-week-old term male infant presented to the emergency department with fever and non-bilious projectile vomiting. Abdominal ultrasonography confirmed HPS and additionally demonstrated a GD cyst measuring 4.2 × 3.6 cm in the left upper quadrant. Further characterization of the cyst was achieved using computed tomography (CT). The patient underwent an uneventful laparoscopic pyloromyotomy, and resection of the duplication cyst was planned as an elective procedure. At 3 months of age, the patient re-presented with abdominal wall swelling, vomiting, and irritability. Abdominal CT imaging demonstrated hemorrhage within the duplication cyst, evidenced by an increase in cyst size and thick internal debris, as well as cyst perforation, leading to the formation of intra-abdominal pseudocysts with fistulous tracts extending to the anterior abdominal wall. An urgent exploratory laparotomy was performed. Using a stapler, the GD cyst was completely excised via wedge resection of the stomach encompassing the lesion. The fistulous tracts were divided, and the pseudocysts were drained. Histopathological examination confirmed a GD cyst containing ectopic pancreatic tissue. The postoperative course was uneventful, and the patient was discharged home on day 10 after surgery. Conclusion: Gastric duplications can contain ectopic pancreatic tissue that can potentially cause perforation of the cyst. Prompt resection of gastric duplications is recommended.