Diagnostics and Operational Treatment of Gastric Duplication in Children

Abstract

Introduction. Duplications of the digestive tract (DDT) are a rare congenital pathology. They have a close anatomical connection with any part of the gastrointestinal tract, are lined with a mucosa and have a fair developed layer of smooth muscles. The DDT prevalence rate amounts of 1:4,500 newborns. According to the literature, in most cases, DDT is diagnosed before the age of two years, being found in both girls and boys with little prevalence in boys. Duplication of the stomach makes up about 4-8% of the duplication of the gastrointestinal tract. Unlike other types of duplication, duplication of the stomach is more often found in girls. Material and methods. There was made a retrospective analysis of the examination and surgical treatment of 13 stomach duplication children which were on treatment at N.F. Filatov Children’s Municipal Clinical Hospital No 13 during the period of from 2011 to 2015. The diagnostic significance of such instrumental methods of research as ultrasound diagnosis, computed tomography (CT), radiopaque examination and fibro-esophagogastroduodenoscopy was analyzed. Minimally invasive interventions were performed in 11 (84.6%) cases. Results. In the diagnosis, ultrasound (ultrasound), CT, esophagogastroduodenoscopy and radiopaque examination were used according to the indications. We consider the ultrasound method to be the most accessible, non-invasive and informative method for diagnosing of DDT. In our series of patients in 8 (61.5%) cases of ultrasound was informative and the echo-picture corresponded to the duplicative cyst of the stomach. Multislice CT was performed in 5 children, out of which in 2 cases the picture corresponded to the duplicating cyst of the stomach, in 3 patients the small omentum cyst, lymphangioma of the small intestine mesentery and pancreas cyst were suspected. Surgical interventions in the vast majority of cases were performed by means of a laparoscopic mode, in 2 cases an open intervention was performed in a 5-month-old child due to the presence of a combined pathology of the pancreatic tumor and also in a 4-month-old child who had undergone a laparotomy in connection with intestinal obstruction. Discussion. Duplications of the stomach make up about 4-8% of the DDT cases. The comparative rarity of this pathology and the absence of reliable pathognomonic signs of the disease make it difficult to establish the correct preoperative diagnosis, despite numerous imaging methods. Clinical manifestations are variable and depend on the location of the mass, its size, the presence of an ectopic mucosa and communication with the lumen of the stomach. To diagnose gastric duplication, various imaging methods are used. We consider the ultrasound method to be the most accessible, non-invasive and informative method for diagnosing the gastric duplication. We consider the ultrasound method to be the most accessible, non-invasive and informative method for diagnosing of DDT duplications. Currently, in all types of DDT, the methods of minimally invasive surgery are tried: thoraco- and laparoscopic, laparoscopic-assisted and intraluminal interventions. Such surgical interventions should comply with the principles of radical surgery: the duplication should be removed completely, and if this is not possible it is necessary to completely remove the mucous membrane. In our study, in all cases, the radical surgical intervention was achieved, while the share of minimally invasive operations was 84.6%.