Surgical Management of Alimentary Tract Duplications

Abstract

Alimentary tract duplications are unusual anomalies that may require surgical intervention in the neonate, infant, and occasionally in the older child. The clinical presentation of patients with alimentary tract duplications includes bleeding, abdominal pain, intussusception, and respiratory distress, or it may be an incidental finding on either abdominal examination or chest x-ray. A review of 96 patients with 101 duplications seen over the last 37 years is reported herein. Twenty-one duplications were confined to the thorax; three were thoracoabdominal, and 77 were abdominal. Seventy-four patients presented as infants less than 2 years of age, and 22 patients were older. Ectopic gastric mucosa was found in 21 duplications, and pancreatic tissue was found in five. Seventy-five duplications were cystic and 26 were tubular. Ultrasonography, computed tomography (CT), and myelography are helpful diagnostic tools. Ninety-four of the 96 patients underwent surgical management for their duplications. One duplication was found at necropsy, and one patient was asymptomatic and did not undergo operation. A single death occurred in a 2-day-old infant who had intrauterine volvulus and meconium peritonitis. Management was based on the age and condition of the patient, the location of the lesion, whether it was cystic or tubular and communicating with the true intestinal lumen, and whether it involved one or more anatomic locations. Generally, total excision was preferred, but staged approaches were sometimes necessary.

Ileocecal duplication cysts: Is the loss of the valve always necessary?

“…Duplications at the IC junction are a particular entity, not clearly identified in all the reported series [5][6][7][8] and generally included into the ileal duplications [9]. Only few Authors described the IC type, for which the operative approach consisted of segmental resection with primary reanastomosis [10,11].…”

A Rare Case of Perforated Tubular Ileal Duplication in 72-Year-Old Male

“…Intestinal resection and anastomosis is required in all cases and include adjacent normal intestine because of common sharing of bowel wall and of blood supply [13,14]. Postoperative outcomes are often favorable.…”

Intestinal duplication

“…If gastric ectopic mucosa is present, then acid secretion from this mucosa can result in peptic ulcer, perforation or bleeding. In one study [4], ectopic gastric mucosa was found in 21 duplications and pancreatic tissue was found in fi ve (out of 101). True duplication has all the layers of the parent gut.…”

“…Some of them may be confi ned to the thorax (21/ 101) [4]. Rarely, they can also present retroperitoneally.…”

“…It estimated to occur in about 1 in 5000 live births. Over 37 years, 101 duplications are seen in 96 patients in a major children's hospital [4]. From this it appears to be quite rare to see many cases in clinical practice.…”