Learning Objectives To present a rare case of acute hemorrhage into a congenital duodenal duplication cyst To review the radiological features on ultrasound, endoscopic ultrasound, computed tomography, and magnetic resonance imaging consistent with duodenal duplication cysts and some associated complications To appreciate the correlation between different imaging modalities and intra-operative findings

Background: Duplication cysts are congenital abnormalities purported to arise as a consequence of recanalization errors of the neonatal GI tract(1). Duodenal duplications make up 2-12% of duplications within the GI tract(2). Diagnosis is typically made in childhood when complications such as haemorrhage, gastric outlet obstruction or pancreatitis result in abdominal pain and/or vomiting necessitating presentation to hospital(2). Radiological differential diagnosis include intramural duodenal haematoma or choledochocele. Standard treatment of duodenal duplication cysts is surgical resection. Duodenal haematomas are often managed conservatively(3)and the treatment of choice...

Case/Imaging Findings: The included case example pertains to a 16-year-old female presenting with acute haemorrhage into a congenital duodenal duplication cyst within the second part of the duodenum (D2) following minor trauma. She presented with mild right sided abdominal pain, nausea but was afebrile without features of peritonism. Initial workup included a white blood cell count of 7.2 x109/L (normal range 4.5 x109/L to 13.0 x109/L), lipase of 93 U/L (normal range <90 U/L), haemoglobin of 102g/L (normal range 120g/L to 160g/L), total bilirubin of...

Conclusion: Duodenal duplication cysts are a rare entity and often a challenging radiological diagnosis. Familiarization with key imaging features across multiple modalities can aid the radiologist with accurate interpretation, as evidenced by the presented case.

References: 1. Bower RJ, Sieber WK, Kiesewetter WB. Alimentary tract duplications in children. Annals of surgery. 1978;188(5):669. 2. Chen J-J, Lee H-C, Yeung C-Y, Chan W-T, Jiang C-B, Sheu J-C. Meta-analysis: the clinical features of the duodenal duplication cyst. Journal of pediatric surgery. 2010;45(8):1598-606. 3. Blank G, Königsrainer A, Sipos B, Ladurner R. Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature. World Journal of Surgical Oncology. 2012;10(1):55. 4. Al-Harake A, Bassal A, Ramadan M, Chour M. Duodenal...