A54 DUODENAL DUPLICATION CYST PRESENTING AS OBSCURE OVERT GASTROINTESTINAL BLEEDING
Bibliographic record
Abstract
Duodenal duplication cysts are very rare congenital malformations that usually present in childhood with recurrent pancreatitis, biliary or duodenal obstruction. Overt bleeding in an adult secondary to a duodenal duplication cyst is an exceedingly rare diagnosis. We report a case of duodenal duplication causing recurrent gastrointestinal bleeding that was successfully managed with endoscopic excision. A detailed review of the case and the literature was undertaken. A 67-year-old lady was referred to the GI clinic with a long history of iron-deficiency anemia since childhood and intermittent melena with unknown etiology. She had multiple upper and lower endoscopic examinations which failed to reveal the etiology of anemia or melena. In September 2016, she had frank melena and an acute hemoglobin drop 70g/L from 99g/L and an urgent upper endoscopy was performed. The endoscopic description was that of two visible lumens at the start of the second part of the duodenum. A culprit lesion was found as an adherent clot on a polypoid protuberance at the distal end of one the lumens. This was managed with Epinephrine injection. A second look endoscopy with transparent hood was performed and demonstrated the ampulla sitting on a septum that separated the true lumen and the lumen of the duodenal duplication cyst. The duodenal duplication cyst was resected in two pieces, during which arterial bleeding was encountered, which was managed with soft coagulation end hemostatic clips. The patient subsequently had no further recurrence of melena and iron deficiency anemia has resolved. Pathology demonstrated a duodenal duplication cyst. This case represents the successful excision of a duodenal duplication cyst with an atypical presentation, in addition to having both ends of the cyst open, which exhibits a unique endoscopic appearance of a double lumen. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".