Alimentary tract duplication cyst refers to congenital malformations that involve the mesenteric side of bowel and share a common wall or blood supply with the bowel. Duplication cyst occurs in any segment of the gastrointestinal tract from mouth to anus, but is more commonly seen in the mesentery of the ileo-colic region. Duplication cyst presents more frequently in children with abdominal pain or swelling. In adults, the diagnosis of duplication cyst is incidental and can present with complications like bleed, fistula formation, inflammatory mass, and rarely malignant transformation. English-language literature review has shown only three cases of malignancies reported so far associated with jejunal duplication cyst. A case of incidentally detected metastatic adenocarcinoma in a jejunal duplication cyst is being reported here, along with literature review of malignancies associated with small bowel duplication cyst.

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Bronchobiliary fistula (BBF) was first described by Peacock in 1850. [1] Bilioptysis is one of the cardinal symptoms. Therefore, the diagnosis is based on symptoms as well as clinical history. Congenital malformations are a rare etiology for BBF; however, acquired etiologies are more common. Pathogenesis involves increased local pressure or infectious condition resulting from infected hydatid cyst, amebic liver abscess, liver trauma, or neoplasm. [2,3] The disease may lead to deferent pulmonary complications, such as recurrent chemical or bacterial pneumonitis, mediastinitis, bronchiolitis, or bronchiectasis. [4] Timely, accurate diagnosis and treatment are critical to the successful outcome. Herein, we describe a rare case of cyst-biliary communication secondary to a hydatid cyst of the liver, associated with BBF and diagnosed by hepatobiliary scintigraphy and exact localization by single-photon emission computerized tomography-computed tomography (SPECT-CT). The functional nature of hepatobiliary scintigraphy enabled the diagnosis and the extent of BBF.