十二指腸閉鎖を呈する十二指腸重複嚢胞に対する内視鏡超音波ガイド下十二指腸空腸吻合術

Duodenal duplications are rare congenital anomalies that can cause gastrointestinal obstruction. Although surgical resection is the standard treatment, endoscopic alternatives are increasingly being explored. Endoscopic ultrasound (EUS)-guided anastomosis techniques have shown promise in treating gastrointestinal obstructions. However, their application in cases of duodenal duplication with obstruction remains technically challenging. We present a case where EUS-guided duodenojejunostomy (EUS-DJ) successfully resolved the duodenal obstruction caused by a duodenal duplication.

A 50-year-old woman with refractory vomiting and severe electrolyte imbalance was diagnosed with a cystic-communicating duodenal duplication causing duodenal obstruction. As the patient declined surgical intervention, we performed an EUS-DJ. Under EUS guidance, a 19-gauge needle was used to puncture the jejunum via the duodenal cavity, followed by placement of a 15 × 10-mm lumen-apposing metal stent to establish a duodenojejunal bypass.

The patient resumed oral intake by postoperative day 3 and was discharged on day 5. One-month imaging confirmed stent patency and resolution of fluid accumulation. She remained symptom-free at 3-month follow-up.

EUS-DJ appears to be a feasible and effective minimally invasive option for managing symptomatic duodenal duplication cysts, particularly in patients who are poor surgical candidates or decline surgery.