Enteric duplication in children

A case report of a giant ileocecal cystic prolapse through the anus and literature review

Intussusception refers to the invagination of a proximal loop of the bowel into an adjacent distal segment. This condition is rare in adults, especially when it involves a complete folding of the ileocecal area out of the body cavity. Meanwhile, enterogenous cysts are congenital malformations that are largely identified in childhood following symptoms of bowel obstruction. While surgical treatment is ultimately required for both diseases, deciding on the type of surgery and the right time to operate can be a challenge for clinicians. It is especially difficult to decide on treatment for an adult with the coincidental occurrence of both conditions and no definitive pathologic diagnosis prior to surgery. Here, we present the case study of a 19-year-old female patient who presented with a prolapsed anus due to intussusception caused by a large ileocecal mass. The patient was admitted to the emergency department with a "massive anal mass." She remained symptomatic after receiving conventional conservative treatment and had to undergo emergency surgery after developing an intestinal obstruction. While the patient's intraoperative condition also confirmed the preoperative CT findings, the situation became more complicated during surgery. The postoperative pathological report indicated the presence of an enterogenous cyst. After recovery from surgery, the patient was successfully discharged. Intussusception or intestinal obstruction caused by an intestinal mass is a surgical indication, and removal is the only way to cure the condition. This case study provides a helpful reference for general surgeons, especially anorectal surgeons, imaging physicians, and pathologists, and informs the diagnosis and treatment of this patient population.

Neonate with congenital pulmonary airway malformation concurrent with enteric duplication cyst: a case report of a rare anomaly

A congenital pulmonary airway malformation (CPAM) occurring concurrently with an enteric duplication cyst is a rare anomaly. Definitive management for both abnormalities is usually surgical resection. We present the uncommon case of a neonate with a CPAM and ileal duplication cyst, including pre-natal and post-natal workup. The patient was brought to the operating room for laparoscopic duplication cyst excision at 3 months of age. The patient returned to the operating room for a thoracoscopic right lower lobectomy at five months of age. This case presents a rare congenital anomaly with the concurrent presentation of a CPAM and enteric duplication cyst, with both being successfully excised minimally invasively.

Surgical management strategy of alimentary tract duplication involving the rectum in children

PURPOSE

Alimentary tract duplication involving the rectum (ATD-R) is rare. The purpose of the study was to describe the features of pediatric ATD-R patients and propose a surgical management strategy.

METHODS

Nine consecutive children operated on for ATD-R at a tertiary center for pediatrics from January 2010 to June 2021 were retrospectively reviewed and followed up. Eighty-six children with the same diagnosis from the literature were reviewed to assist the investigation. Classifications of ATD-R consisted of cystic, tubular, and diverticular.

RESULTS

Surgical treatment and histopathological examination identified six females and three males with ATD-R. Initial clinical symptoms included perianal lesions, abnormal discharge, and anorectal malformation (ARM). Apart from one tubular ATD-R patient with cloaca malformation, the other eight patients had normal-developed anorectum. Complete or partial lesion resection maintaining the integrity of the proper colorectum was a principle of surgery. Six patients were followed up for a median time of 71 (range 12-121) months with good prognoses. A surgical management strategy of ATD-R in children was proposed.

CONCLUSIONS

ATD-R commonly occurred concurrently with normal-developed anorectum, seldom combined with ARM. ATD-R should be considered as a differential diagnosis in anorectal symptoms. The timely and appropriate operation was curative.

Ileocecal duplication in children: a single-center experience of 115 cases

To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children. A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal intraluminal (n = 41), ileal extraluminal (n = 24), ileocecal valve (n = 11), cecal intraluminal (n = 18), and cecal extraluminal (n = 3) types according to their locations. Median age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P = 0.004). Ileocecal resection and ileocolostomy and cyst excision without ileocecal resection were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision without ileocecal resection performed in patients with different types were 78.0% (32/41), 91.7% (22/24), 27.3% (3/11), 27.8% (5/18), and 100.0% (3/3) (P < 0.001). Time of oral intake (P = 0.003) and hospital stay after surgery (P < 0.001) were significantly shorter in patients undergoing cyst excision without ileocecal resection. There were no significant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P = 0.008).

CONCLUSIONS

Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection.

WHAT IS KNOWN

• How to address ileocecal duplication has always been challenging in clinical management. • Children who have an ileocecal resection can develop some early postoperative complications.

WHAT IS NEW

• Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. • Children's growth and defecation patterns do not seem to be affected by ileocecal resection.

Clinical features of colorectal duplication in children: A study of 25 cases

PURPOSE

To describe the clinical features and surgical management of pediatric colorectal duplication.

METHODS

Twenty-five patients with colorectal duplication at Beijing Children's Hospital between January 2010 and December 2020 were reviewed. Colorectal duplications were divided into cystic, diverticular, tubular and mixed types according to shape.

RESULTS

Of the patients, 64% were female, and 44% had accompanying malformations. Abnormal prenatal ultrasound findings (24%), abnormalities immediately found after birth (28%), and postnatal subjective symptoms (48%) were the main clinical presentations. Cystic lesions were observed in 16 patients (64%), including 12 in the colon and 4 in the rectum. Diverticular lesions were observed in 4 patients (16%), and all originated from the sigmoid colon. Among the 4 patients (16%) with tubular lesions, 3 involved the total colon, and the other originated from the splenic flexure to the proximal sigmoid colon. The patient with mixed duplication presented an intact enteric cyst within tubular duplication of the total colon. The mean age at surgery was 20 (0.3-130) months. Except for 4 total colon duplications, complete surgical resection of duplication lesions was performed in all patients. The "distal cross-section, mucosa stripping, and closure" procedure was performed in 3 patients with total colon duplication. Eighteen patients (72%) were followed up for a median time of 54.5 (5-129) months and recovered uneventfully.

CONCLUSIONS

Owing to various clinical presentations, colorectal duplication requires careful preoperative differential diagnosis. Complete surgical resection is the preferred radical method for treating cystic, diverticular and short tubular colorectal duplications, except for total colon duplications.

LEVEL OF EVIDENCE

Level IV.

Gastric-Type Enteric Duplication Cyst Communicating with an Accessory Pancreatic Duct

Enteric duplication cysts are rare congenital anomalies defined by the location along the gastrointestinal tract from which they communicate as well as the epithelial lining they contain. Enteric duplication cysts in communication with the pancreas are an even rarer subset that are often difficult to diagnose due to nonspecific presenting symptoms. In a pediatric patient with a history of recurrent pancreatitis episodes, a pancreatic duplication should be on the differential. High clinical suspicion and specific imaging characteristics can aid in the diagnosis. The management of pancreatic duplication cysts requires surgical excision or drainage procedures to alleviate symptoms and prevent associated complications such as recurrent pancreatitis, bleeding, bowel obstruction, or malignancy. Here we present a case of a gastric duplication cyst in communication with an accessory pancreatic lobe with special focus on the preoperative workup, intraoperative findings, and histopathologic examination. [Pediatr Ann. 2022;51(8):e324-e327.].

Communicating multiple tubular enteric duplication with toxic megacolon in an infant: A case report

RATIONALE

Gastrointestinal tract duplication is a rare congenial anomaly which can be found anywhere along the gastrointestinal tract. While many patients are incidentally diagnosed during operation, in some cases it can present with severe gastrointestinal symptoms. In this case report, the patient presented with signs of toxic megacolon leading to rapid aggravation of inflammatory shock.

PATIENT CONCERNS

A 49-day old male infant presented with fever, poor feeding, and severe abdominal distension.

DIAGNOSIS

Abdominal ultrasonography was done. During the examination, a foley catheter was inserted through the anus to evaluate bowel patency and enable rectal decompression. The tip of the foley catheter was located in a separate narrower tubular lumen adjacent to the distended rectum. These findings suggested possibility of a tubular duplication cyst of the rectum as the culprit for the bowel obstruction.

INTERVENTIONS

The patient underwent emergency laparotomy. Findings showed multiple tubular intestinal duplications involving the ileum, appendix, cecum, descending colon, sigmoid colon and rectum. The true lumen of the rectosigmoid colon was completely collapsed while the adjacent tubular cyst remained severely distended and stool passage was not possible. Decompression of the sigmoid colon was done with loop colostomy with both the wall of the true bowel and enteric cyst forming the colostomy orifice.

OUTCOMES

After 40 days of postoperative care, the patient was discharged with no immediate complications. Four months after the initial operation, colostomy take-down and transanal rectal common wall division was done. No complications were observed.

LESSONS

To our knowledge, this is the first case to be reported where a rare presentation of intestinal duplication resulted in an acute presentation toxic megacolon. Such emergency cases can be effectively treated with emergency surgical bowel decompression and elective common wall division.

Ruptured duplication cyst of transverse colon

Duplication cysts of gastrointestinal tract are rare congenital abnormalities found in 0.2% of children. We report a rare case of a ruptured duplication cyst of transverse colon in a 7-year-old female child who presented with abdominal pain and mass in the right iliac fossa. We assumed it as an appendicular mass; however, it turned out to be a ruptured duplication cyst of transverse colon. Only two cases of duplication cyst of transverse colon have been reported yet in the literature.

Prenatal Imaging Diagnosis of Suprarenal Lesions

INTRODUCTION

Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses.

METHODS

This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed. Prenatal imaging findings were compared by the most common diagnoses and regression patterns.

RESULTS

Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (n = 12; 27.3%), adrenal hemorrhage (n = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (n = 4), adrenal hyperplasia (n = 3), bilateral adrenal calcifications (n = 1), and indeterminate lesions (n = 6). Sequestrations were uniformly left-sided (100 vs. 50%; p = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (p = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (p = 0.005), low T1 MRI signal (p = 0.015), and no MRI blood products (p = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (p = 0.003; p = 0.044).

DISCUSSION/CONCLUSION

Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.

Alimentary Tract Duplication in Pediatric Patients: Its Distinct Clinical Features and Managements

PURPOSE

Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features.

METHODS

We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared.

RESULTS

A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion (p=0.012).

CONCLUSION

ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion.

Ileal bronchogenic cyst: A case report and review of literature

We herein report a rare case of ileal bronchogenic cyst that was found in a 39-year-old Chinese man. He had no symptoms and the physical examination was normal. Tumor markers were within the normal range. Abdominopelvic enhanced computed tomography showed a mass in the lower abdominal cavity and the tumor had a complete capsule. Diagnostic laparoscopy was then performed, which showed that a spheroid mass with a complete capsule was located at the antimesenteric border of the distal ileum 20 cm from the ileocecal valve, measuring 6.0 cm × 6.0 cm × 5.0 cm. Considering that the malignancy of the tumor cannot be ruled out, and there is a risk of rupture during laparoscopic surgery, the patient was converted to an open surgery. Partial resection of the ileum with the tumor was performed, followed by a side-to-side anastomosis. The tumor was gray-red in color, filled with grayish yellow mucus and had no septum. The postoperative pathology revealed that the cystic wall was lined by pseudostratified ciliated columnar epithelium without cellular atypia. The wall consisted of bronchial mucous glands and smooth muscle fibers, and no abnormalities were found in adjacent ileum tissues. Thus, a diagnosis of bronchogenic cyst of the ileum was made.