Duodenal Duplication Cyst in an Old Man muscles. In contrast, choledochoceles are lined by either a bile duct or gallbladder mucosa and lack a smooth muscle layer (14). DDCs have been traditionally treated with surgery. The surgical approach should be made in accordance with the relationship between the cyst wall and the biliary and pan- creatic drainage systems. The surgical goal is the free drainage of the cyst into the duodenum without damaging the biliary and pancreatic ducts. Occasionally, the close relationship bet- ween the DDC and the pancreaticobiliary system makes sur- gery difficult and risky. In these cases an endoscopic proce- dure appears to be a reasonable option (4, 5). A total excision of the cyst prevents further hazards including the develop- ment of a malignancy that may arise from the residual ectopic gastric mucosa (6). Thus, our case was treated with a pylorus- preserving pancreaticoduodenectomy, which cured the patient. REFERENCES 1. Browning RW. Duodenal duplications. Rev Surg 1963; 20: 226-9. 2. Gross RE, Holcomb GW Jr, Farber S. Duplications of the alimenta- ry tract. Pediatrics 1952; 9: 449-68. 3. Rubin RB, Saltzman JR, Zawacki JK, Khan A, Swanson R. Duode- nal duplication cyst with massive gastrointestinal bleeding. J Clin Gastroenterol 1995; 21: 72-4. 4. Wada S, Higashizawa T, Tamada K, Tomiyama T, Ohashi A, Satoh Y, Sugano K, Nagai H. Endoscopic partial resection of a duodenal duplication cyst. Endoscopy 2001; 33: 808-10. 607 5. Sezgin O, Altiparmak E, Yilmaz U, Saritas U, Sahin B. Endoscopic management of a duodenal duplication cyst associated with biliary obstruction in an adult. J Clin Gastroenterol 2001; 32: 353-5. 6. Falk GL, Young CJ, Parer J. Adenocarcinoma arising in a duodenal duplication cyst: a case report. Aust N Z J Surg 1991; 61: 551-3. 7. Narlawar RS, Rao JR, Karmarkar SJ, Gupta A, Hira P. Sonographic findings in a duodenal duplication cyst. J Clin Ultrasound 2002; 30: 566-8. 8. Zamir G, Gross E, Shmushkevich A, Bar-Ziv J, Durst AL, Jurim O. Duodenal duplication cyst manifested by duodeno-jejunal intussus- ception and hyperbilirubinemia. J Pediatr Surg 1999; 34: 1297-9. 9. Arbell D, Lebenthal A, Blashar A, Shmushkevich A, Gross E. Dupli- cation cyst of the duodenum as an unusual cause of massive gastroin- testinal bleeding in an infant. J Pediatr Surg 2002; 37: E8. 10. Fan ST, Lau WY, Pang SW. Infarction of a duodenal duplication cyst. Am J Gastroenterol 1985; 80: 337-9. 11. Ogura Y, Kawarada Y, Mizumoto R. Duodenal duplication cyst com- municating with an accessory pancreatic duct of Santorini. Hepato- gastroenterology 1998; 45: 1613-8. 12. Richer JP, Faure JP, Maillot N, Silvain C, Levillain P, Carretier M. Duodenal duplication cyst communicating with the bile duct with a long common biliary-pancreatic channel. Eur J Surg 2000; 166: 504-7. 13. Keller MS, Weber TR, Sotelo-Avila C, Brink DS, Luisiri A. Duo- denal duplication cysts: A rare cause of acute pancreatitis in chil- dren. Surgery 2001; 130: 112-5. 14. Reinus FZ, Weingarten G. Choledochocele of the common bile duct. Am J Surg 1976; 132: 646-8.