An unusual case of cystic dystrophy of the duodenal wall

Cystic dystrophy of the duodenal wall (CDDW) is an infrequent disease characterized by a chronic inflammation of the aberrant pancreatic tissue in the duodenal wall. A 60-year-old woman was admitted with several months of upper right abdominal discomfort, vomiting after meals and a 15 kg weight loss. The diagnosis of a CDDW was initially suspected in an abdominal US examination, which revealed an oval solid mass (4.3 cm × 2.7 cm) with a considerable cystic component between the slightly enlarged pancreatic head and the thickened medial wall of the duodenal vertical branch. A contrast-enhanced CT revealed a fibrous parietal thickening and a big ovoid mass of fluid density, divided by the septa, in the space between the pancreatic head and the second portion of the duodenum. The uncinate process and lower part of the head were enlarged, with bumpy contours, non-uniform fibrosis and a great number of calculi in the parenchyma, whereas the body, tail and upper parts of the pancreatic head remained unaffected. The diagnosis of CDDW was confirmed by an endoscopic US and pylorus preserving pancreatoduodenectomy.The case described is of interest because of an unaffected major papilla and an unusual volume of orthotopic pancreas involvement by chronic inflammation.