Clinical Brief Correspondence and Reprint requests : Dr Yogesh Kumar Sarin, MBBS, MS, DNB, MCh, MBA, Department of Pediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi-110002, India. [DOI-10.1007/s12098-009-0307-7] [Received November 01, 2008; Accepted April 16, 2009] Bronchopulmonary Foregut Malformation Mimicking Pseudocyst of Pancreas Nilesh G Ngdeve, Vivek Manchanda and Yogesh K Sarin Department of Pediatric Surgery, Maulana Azad Medical College, and Associated Lok Nayak Hospital, New Delhi, India ABSTRACT We report a four-yr-old girl who was successfully treated for a large gastro-duodenal duplication that communicated with extra-lobar pulmonary sequestration on one end and the main pancreatic duct on the other. Such an association has not been reported hitherto. [Indian J Pediatr 2010; 77 (3) : 323-325] E-mail: yksarin@hotmail.com Key words: Bronchopulmonary foregut malformation; Pulmonary sequestration; Gastro-duodenal duplication cyst; pancreatic pseudocyst The term bronchopulmonary foregut malformation (BFM), coined by Gerle et al in 1968, describes rare cases of pulmonary sequestrations having patent communications with the upper gastrointestinal tract. 1 Though BFM includes a diverse group of disorders, one of its rare variant is duplication cyst communicating with extralobar pulmonary sequestration. On extensive search of English literature, we could trace only eight cases of such an association. 2-9 We report here a four-yr- old girl who was successfully treated for a large gastro- duodenal duplication that communicated with extra- lobar pulmonary sequestration on one end and the main pancreatic duct on the other. The simultaneous presence of relapsing pancreatitis was unique and led to misdiagnosis and she was treated for pancreatic pseudocyst for a long time, before a correct diagnosis of complex gastro-duodenal duplication could be made intra-operatively. REPORT OF CASE A 4-yr-old girl was referred to us with recurrent upper abdominal pain of two year duration. The episodes of pain were associated with high-grade fever, non- bilious vomiting and occasionally melena. She had lost weight and had persistent anemia requiring frequent blood transfusions. There was no history of abdominal trauma. Except for pallor, physical examination showed no abnormalities. On more than one occasions, serum amylase levels were found significantly raised (levels upto 1500 IU/l). Ultrasonography and computed tomography of the abdomen done previously revealed a cystic well-defined, thick walled lesion adherent to the anterior surface of pancreas. Pancreas and rest of abdominal viscera were normal. The patient was then referred to gastroenterologist. On further investigations, hematological evaluation showed normocytic hypochromic anemia. Blood chemical and enzyme levels were normal, except that the serum amylase level was 550 IU per liter (normal range, 20-110 IU per liter). MRI abdomen showed rounded cystic lesion anterior to pancreas that had a Fig. 1. Coronal section MRI showing the location of the gastric duplication cyst in lesser sac. Indian Journal of Pediatrics, Volume 77—March, 2010 323