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Higashidate N, Sakamoto S, Saikusa N, Koga Y, Masui D, Nakahara H, Nakamura M, Saikusa M, Kinoshita M, Kaji T. Tubular intestinal duplication extending from the stomach to the ileum associated with multiple intestinal atresia and situs inversus: a case report. Surg Case Rep 2023; 9:141. [PMID: 37556040 PMCID: PMC10412515 DOI: 10.1186/s40792-023-01728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Duplication of the alimentary tract can occur in any of its parts. For duodenal duplication, complete resection is particularly difficult when the ampulla of Vater is on the duplicated lumen and a deliberate management is necessary. CASE PRESENTATION A 0-day female baby was referred to our department due to abdominal distention. The X-ray examination showed dextrocardia and opacity of the liver on the left side and abdominal ultrasonogram revealed remarkable intestinal dilatation. Therefore, urgent laparotomy was performed on the day of birth. Complete situs inversus of the abdominal organs was revealed, and the origin of the jejunum was on the left side and was accompanied by tubular intestinal duplication. The origin of the duplicated intestine was at the pancreatic head's dorsal area. There were two points of type Шa atresia on the ileum. Therefore, we spared the duplicated intestine with a length of 3 cm to secure the passage of the biliary and pancreatic juices by a functional-side-to-side anastomosis with a 45-mm Endo-GIA™ camel load (Medtronic, Minneapolis, MN, USA). The ileum was transected at the distal side of the atresia point, and end-to-end jejunoileostomy was performed. Postoperative gastrointestinal series revealed remnants of the duplicated alimentary tract on the dorsal area of the stomach. CONCLUSIONS Identifying the position of the ampulla of Vater is crucial in the surgery of alimentary tract duplication with duodenal involvement. However, in the present case, it was difficult to identify whether the ampulla of Vater was on the true or duplicated lumen, and we had to spare the duplicated duodenum. Stapler anastomosis could be performed safely even in neonatal cases.
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Affiliation(s)
- Naruki Higashidate
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Saki Sakamoto
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuyuki Saikusa
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshinori Koga
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Daisuke Masui
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hirotomo Nakahara
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Misa Nakamura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Mamoru Saikusa
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masahiro Kinoshita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Imaging congenital anomalies of the ileum in adults:a pictorial review. Abdom Radiol (NY) 2023; 48:502-509. [PMID: 36401130 DOI: 10.1007/s00261-022-03739-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.
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Niwa Y, Tominaga K, Kawata Y, Kobayashi T, Mizuwasa T, Takahashi K, Sato H, Kohisa J, Abe S, Kamimura K, Yokoyama J, Kawai H, Sugino H, Umezu H, Hirai Y, Nakano M, Shimada Y, Kameyama H, Wakai T, Terai S. Intestinal duplication diagnosed preoperatively with double-balloon enteroscopy: an extremely rare case report and literature review. Clin J Gastroenterol 2022; 15:381-387. [DOI: 10.1007/s12328-022-01596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
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Siragusa L, Pathirannehalage Don C, Benavoli D, Diacinti D, Manenti G, Pocci M, Palmieri G, Rossi P. Completely Isolated Enteric Duplication Cyst and Incidental Neuroendocrine Tumor of the Appendix: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923988. [PMID: 32829376 PMCID: PMC7467633 DOI: 10.12659/ajcr.923988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Female, 26-year-old Final Diagnosis: Completely isolated enteric duplication cyst and appendiceal neuroendocrine tumor Symptoms: Dysmenorrhea Medication: — Clinical Procedure: — Specialty: Oncology • Surgery
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Affiliation(s)
- Leandro Siragusa
- Department of Surgery, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Davide Diacinti
- Department of Radiology, Tor Vergata University of Rome, Rome, Italy
| | - Guglielmo Manenti
- Department of Radiology, Tor Vergata University of Rome, Rome, Italy
| | - Marco Pocci
- Histopathologic Unit, Tor Vergata University of Rome, Rome, Italy
| | | | - Piero Rossi
- Department of Surgery, Tor Vergata University of Rome, Rome, Italy
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Huang ZH, Wan ZH, Vikash V, Vikash S, Jiang CQ. Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin. SAO PAULO MED J 2018; 136:89-93. [PMID: 29236936 PMCID: PMC9924164 DOI: 10.1590/1516-3180.2017.0184030817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022] Open
Abstract
CONTEXT To study the previously discovered clinical entity of adult intestinal duplication and its treatment, and propose an extension to its existing classification. CASE REPORT We report the case of an adult male with abdominal pain, constipation and vomiting. This patient underwent surgical separation of adhesions, reduction of torsion and intestinal decompression. Postoperative pathological findings confirmed the rare diagnosis of intestinal duplication. CONCLUSION Adult intestinal duplication is quite rare. Its clinical manifestations are nonspecific. From this finding of intestinal duplication originating at the opposite side of the mesenteric margin, a further extension of the existing anatomical classification is proposed.
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Affiliation(s)
- Zhi-Hao Huang
- MD, MSc. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
| | - Zi-Hao Wan
- MD, MSc. Surgeon, Department of Orthopedic Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
| | - Vikash Vikash
- MD, PhD. Physician, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
| | - Sindhu Vikash
- MD, PhD. Physician, Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan.
| | - Cong-Qing Jiang
- MD, PhD. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
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Nadatani Y, Watanabe T, Sugawa T, Eguchi S, Shimada S, Otani K, Yamagami H, Tanigawa T, Shiba M, Tominaga K, Fujiwara Y, Arakawa T. Double-balloon endoscopy WAS effective in diagnosing small intestinal duplication: a case report. SPRINGERPLUS 2016; 5:1598. [PMID: 27652171 PMCID: PMC5028348 DOI: 10.1186/s40064-016-3256-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ileal duplications are encountered infrequently in adults, because symptoms including abdominal pain, intussusception, hemorrhage, and perforation usually present in early childhood. In this report, we present an adult case of ileal duplication that was revealed by double-balloon endoscopy (DBE). CASE DESCRIPTION A 73-year-old Japanese man presented with anemia and melena. Anal DBE detected the narrow opening of an extra lumen in the ileum about 100 cm proximal to the ileocecal valve. Enteroclysis via DBE showed a 5-cm-long ileal diverticulum-like structure at the mesenteric side of the ileum. No ectopic gastric mucosa was detected by technetium-99m pertechnetate scintigraphy. The final diagnosis was ileal duplication. DISCUSSION AND EVALUATION This is the first report of tubular ileal duplication diagnosed by using DBE. The small intestinal duplication opening was not detected by using VCE and plane CT in this case, but was found by using DBE. CONCLUSIONS The present case demonstrates that DBE was useful in the diagnosis of an adult small intestinal duplication that was not visualized by other modalities.
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Affiliation(s)
- Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan ; SAMURAI GI Research Centre, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, 545-8585 Japan
| | - Takashi Sugawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Shinpei Eguchi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Sunao Shimada
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan ; SAMURAI GI Research Centre, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, 545-8585 Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
| | - Kazunari Tominaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan ; SAMURAI GI Research Centre, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, 545-8585 Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan ; SAMURAI GI Research Centre, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, 545-8585 Japan
| | - Tetsuo Arakawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585 Japan
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Gastrointestinal Stromal Tumor Arising From a Gastric Duplication Cyst. ACG Case Rep J 2016; 3:175-7. [PMID: 27144196 PMCID: PMC4843148 DOI: 10.14309/crj.2016.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/17/2015] [Indexed: 01/30/2023] Open
Abstract
Gastric duplication cysts (GDC) are rarely diagnosed in adults, but previous cases have been associated with malignancy. We present a case of gastrointestinal stromal tumor (GIST) arising from a GDC in a 71-year-old woman who presented with 3 years of early satiety, anorexia, abdominal distention, and weight loss. Abdominal CT showed a 9.3 x 5.2 x 9.5-cm well-circumscribed cystic mass arising 3 cm above the gastroduodenal junction. The cyst was resected, and histopathology was consistent with GDC. Future studies are needed to clarify the malignant potential of GDC and the molecular pathways for its development.
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Ikemura M, Kunita A, Miwa Y, Jimbo K, Mori K, Seto Y, Fukayama M. Gut wall replacing type of gastrointestinal stromal tumor presenting as a perforation of the ileal diverticulum. Pathol Res Pract 2015; 211:892-5. [DOI: 10.1016/j.prp.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 12/16/2022]
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Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J Gastroenterol 2014; 20:9990-9997. [PMID: 25110427 PMCID: PMC4123378 DOI: 10.3748/wjg.v20.i29.9990] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/21/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Spontaneous free perforation of the small intestine is uncommon, especially if there is no prior history of visceral trauma. However, free, even recurrent, perforation may complicate a defined and established clinical disorder, such as Crohn’s disease. In addition, free perforation may be the initial clinical presentation of an occult intestinal disorder, such as a lymphoma complicating celiac disease, causing diffuse peritonitis and an acute abdomen. Initial diagnosis of the precise cause may be difficult, but now has been aided by computerized tomographic imaging. The site of perforation may be helpful in defining a cause (e.g., ileal perforation in Crohn’s disease, jejunal perforation in celiac disease, complicated by lymphoma or collagenous sprue). Urgent surgical intervention, however, is usually required for precise diagnosis and treatment. During evaluation, an expanding list of other possible causes should be considered, even after surgery, as subsequent management may be affected. Free perforation may not only complicate an established intestinal disorder, but also a new acute process (e.g., caused by different infectious agents) or a longstanding and unrecognized disorder (e.g., congenital, metabolic and vascular causes). Moreover, new endoscopic therapeutic and medical therapies, including use of emerging novel biological agents, have been complicated by intestinal perforation. Recent studies also support the hypothesis that perforation of the small intestine may be genetically-based with different mutations causing altered connective tissue structure, synthesis and repair.
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Shoji M, Yoshimitsu Y, Maeda T, Sakuma H, Nakai M, Ueda H. Perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum in adulthood: report of a case. Surg Today 2013; 44:2180-6. [PMID: 24052432 DOI: 10.1007/s00595-013-0732-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/04/2013] [Indexed: 12/14/2022]
Abstract
A 61-year-old man was referred to us for investigation of acute abdominal pain. Computed tomography showed a 5.9 × 5.3 × 5.0 cm lump of food residue in the jejunum, and a large amount of free air and ascites around the liver and right paracolic gutter. He underwent emergency laparotomy for suspected peritonitis from perforation by a foreign body in the small intestine. We identified purulent exudate in the abdominal cavity and perforation of a jejunal cystic mass, attached ~40 cm from Treitz's ligament at the anti-mesenteric side of the jejunum. Based on a diagnosis of jejunal duplication with perforation, we resected that part of the small intestine and performed intra-abdominal drainage. Pathological findings confirmed the diagnosis of a perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum. Histopathological evidence suggests that intestinal pressure and/or hemorrhage can cause perforation in the background of a true jejunal diverticulum. To our knowledge, this is the first case report of a perforated GIST in a true jejunal diverticulum.
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Affiliation(s)
- Masatoshi Shoji
- Department of Surgery, Hoju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan,
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Adult ileal duplication revealed by a colon adenoma. Surg Today 2013; 43:1335-6. [DOI: 10.1007/s00595-013-0637-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/24/2012] [Indexed: 11/24/2022]
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Ma H, Xiao W, Li J, Li Y. Clinical and pathological analysis of malignancies arising from alimentary tract duplications. Surg Oncol 2012; 21:324-30. [PMID: 23025911 DOI: 10.1016/j.suronc.2012.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/02/2012] [Accepted: 09/03/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malignant change is a rare complication of alimentary tract duplications. METHODS Articles concerning malignancies arising from alimentary tract duplications published from 1955 to 2012 on PubMed were extensively reviewed. These cases were reclassified and analyzed according to sites of clinical manifestations, diagnostic examinations, methods of management, pathological findings, clinical staging and prognosis. RESULTS There were 64 citations in the literature that provided adequate descriptions of 67 cases of malignancies arising from alimentary tract duplications near the oesophagus (n = 6), stomach (n = 10), small intestine (n = 19), appendix (n = 1) and large intestine (n = 31). Among the cases described above, 57 underwent surgical treatment. In 43 patients with known prognosis, 7 died of tumour progression. In another 5 cases, the tumours recurred and metastasized recurred and metastasised after surgery at an average of 11.4 months. CONCLUSIONS For relieving symptoms and preventing malignant change, all duplications should be considered for surgery. Unfortunately, prognosis is generally poor once malignancy has occurred in the duplications.
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Affiliation(s)
- Haifen Ma
- Department of Pathology, Beilun People's Hospital, Ningbo City, Zhejiang Province, China.
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