Duplications of the Alimentary Tract

Triplication of small bowel with perforated peptic ulcer: Report of a rarity with literature review

“…In the case we describe here, the patient had a history of bleeding per rectum treated conservatively without a clear diagnosis. In cases where no gastric tissue is found in ED, an increased intra‐luminal pressure especially in non‐communicated type can lead to perforation or causes abscess formation and acute abdomen 19 . Another explanation for perforation of ED is the accumulation of secretion and enterolith formation in the non‐communicated type as evident by review of some reported cases 20 or it may be due to poor blood supply.…”

“…Excision of ED with a segment of adjacent bowel is the optimal treatment because it usually shares a common wall and blood supply and this can be done via laparoscopy if duplication is of the small cystic type 26 or laparotomy for the long tubular type, or when the patient presents with complications. Sometimes opening of the muscular wall of ED with mucosal stripping is another option when there is a risk of resecting the ileo‐caecal valve or when excision of a long tubular duplication together with the adjacent bowel will lead to the development of short bowel syndrome 19,25 . Some duplications can be treated by resection and doing Bianchi procedure using the split mesentery technique 27 .…”

“…In cases where no gastric tissue is found in ED, an increased intra-luminal pressure especially in non-communicated type can lead to perforation or causes abscess formation and acute abdomen. 19 Another explanation for perforation of ED is the accumulation of secretion and enterolith formation in the non-communicated type as evident by review of some reported cases 20 or it may be due to poor blood supply. About 75% of ED usually receive their main blood supply from one leaf of the mesentery, making it vulnerable to ischaemia, while 25% of ED are embedded deep in the mesentery receiving a good blood supply from both mesenteric leaves.…”

“…Sometimes opening of the muscular wall of ED with mucosal stripping is another option when there is a risk of resecting the ileo-caecal valve or when excision of a long tubular duplication together with the adjacent bowel will lead to the development of short bowel syndrome. 19,25 Some duplications can be treated by resection and doing Bianchi procedure using the split mesentery technique. 27 Other surgeons advise to open the non-communicated duplication at its distal end to the adjacent bowel to provide drainage, but this will not remove the risk of bleeding if any heterotrophic gastric tissue is present.…”