Alimentary tract duplications in children: high incidence of associated anomalies

Thoracoabdominal duplication accompanied by intestinal malrotation: a case report and literature review of a rare congenital anomaly in an infant

Introduction and importance

Thoracoabdominal duplication and intestinal malrotation are extremely rare congenital alimentary tract anomalies that can manifest in any segment of the gastrointestinal tract. Still, tubular duplications are an even rarer subset of alimentary tract duplications. Misdiagnosis could occur and this will yield devastating ramifications. Therefore, consideration in the clinical settings is warranted to aid in conducting timely therapeutic interventions.

Case presentation

In this article, we illustrate the overwhelmingly rare occurrence of thoracoabdominal duplication coexistent with intestinal malrotation in a 7-month-old male whose primary complaint was chronic dyspnoea since birth that progressed to involve cough and fever. Imaging analysis revealed a significant intrathoracic fluid-filled cyst.

Clinical discussion

The intestinal malrotation was treated through Ladd's procedure, and surgical excision of the duplicated segments was accomplished. The subsequent analysis of the resected specimens via means of histopathology utilizing Hematoxylin and Eosin dyes established the definitive diagnosis of a foregut duplication cyst.

Conclusion

Thoracoabdominal duplication is one of the most crucial topics in the field of Paediatric Surgery. It is exceptionally rare in occurrence, and the scarcity of available resources that document and describe this topic is evident in the published literature. The authors must opt to document, study, and broaden awareness regarding this life-threatening pathology so that they can circumvent the resultant complications by means of early detection and the performance of apt surgical interventions. Upon careful review of the available literature, we can state that ours is the first-ever case documented from their country regarding this topic and this co-incidence.

Cecal duplication cyst in an infant presenting as shock: A case report

BACKGROUND

Although intestinal obstruction is one of the most common surgical emergencies in an infant, it is difficult to diagnose neonatal enteric duplication cysts (EDC) preoperatively owing to their rarity as a cause of intestinal obstruction. We describe a case report of a neonatal EDC presenting intestinal obstruction and shock.

CASE SUMMARY

A 32-d-old male infant with a prenatal sonographic finding of bladder distension was admitted to our hospital for a severely distended abdomen, fever, and oliguria. The first diagnostic hypothesis was septic shock and intestinal obstruction. The patient's symptoms worsened; following an emergency surgical exploratory laparotomy and histopathological findings, the final diagnosis of cecal duplication cyst was confirmed. The patient's postoperative course was uneventful, and on the fifth postoperative day, oral feeding restarted. Twenty days later, the patient was discharged from the hospital.

CONCLUSION

Although EDC located in the cecum is exceptional, it should be considered when evaluating suspected intestinal obstruction and shock.

Thoraco-abdominal duplications in children: Two case reports

Introduction

Thoraco-abdominal duplication is rare congenital malformations of the notochord that occurs in only 2% of cases of alimentary tract duplications.

We report two rare cases of thoraco-abdominal duplication, emphasizing the value of radiological assessment and discussing the place of diagnostic and therapeutic laparoscopy.

Presentation of case

It was a 12-year-old girl and an 8-month-old boy, admitted for epigastralgia and dysphagia with respiratory distress respectively. Imaging was in favor of pancreatic duplication with intra-thoracic extension for the first patient and gastro-esophageal duplication for the second. A mass excision was done laparoscopically for the first and by a thoracotomy for the second. The aftermath of the surgery was simple in both cases.

Clinical discussion

Thoraco-abdominal duplications are rare congenital malformations that account for only 2% of cases of gastrointestinal duplications. Their diagnosis is difficult since the revealing symptomatology is not common. The treatment is only surgical is facilitated by the laparoscopy which has a diagnostic and therapeutic interest.

Conclusion

Our case reports focused on the difficulty of the diagnosis that is done by imaging and is confirmed by surgery with anatomopathological examination of the excised mass. Diagnostic and therapeutic minimally invasive approach should be used whenever possible.

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Thoraco-abdominal duplications account for only 2% of cases of gastrointestinal duplications.

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Their diagnosis is difficult since the revealing symptomatology is not common.

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The treatment depends on the type of duplication.

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This management is facilitated by the laparoscopy.

Accessory pancreatic lobe in association with a gastric duplication cyst

Gastric duplication cysts are an extremely rare anomaly with few reported cases in association with accessory pancreatic tissue. Diagnosis can be challenging given a presentation of recurrent pancreatitis and resemblance to pancreatic pseudocysts. We report the case of a 6-year old boy with multiple episodes of pancreatitis who was discovered to have an accessory pancreatic lobe connected to a gastric duplication cyst, successfully treated with surgical excision.

Neonatal Intestinal Obstruction: When to Suspect Duplication Cyst of Bowel as the Cause

Background: Duplication cyst is a rare cause of neonatal intestinal obstruction. Their most common location is the small intestine. The clinical presentation is extremely variable depending upon its size, location and type and the age of the patient and are mainly encountered during infancy or early childhood. The diagnosis is very difficult in neonates. This study was undertaken to study their presentation, diagnostic modality of choice and further management in neonatal age group.

Materials and Methods: This was a retrospective study performed at the Department of Paediatric Surgery, J .N Medical College Hospital, AMU Aligarh from July 2008 to June 2014. The data was analyzed with respect to demographic profile of the neonates, their initial clinical presentation, radiological features and subsequent event leading to intervention, operative features and outcome.

Results: There were a total of seven neonates between ages of 3 days and 21 days who were diagnosed as cases of intestinal obstruction due to duplication cyst. The majority of the patients were having ileal duplication cyst (n=4). Ultrasonography played important role in majority of the cases for diagnosis. There was one patient in which the diagnosis was confused with ileal atresia. All the patients underwent excision with restoration of bowel continuity.

Conclusion: The diagnosis of intestinal obstruction in neonate due to duplication cyst is difficult. It has varied presentation and preoperative diagnosis at times may be challenging. Surgery is the mainstay of the treatment.

Alimentary tract duplications in newborns and children: diagnostic aspects and the role of laparoscopic treatment

Alimentary tract duplications are rare congenital lesions normally diagnosed in newborns and children that can occur anywhere from the mouth to the anus and have a reported incidence of approximately 1 in 4500 life births. Symptoms and clinical presentation vary greatly. The presentation varies according to age and location. The treatment finally is surgical; total resection when possible should be the aim of the intervention. In pediatric surgery minimally invasive surgical procedures became more and more important over the last decades. In consequence the operative procedure on alimentary tract duplications changed in this manner. We review on case reports and clinical reports on minimally invasive surgery in the treatment of alimentary tract duplications, determine the importance of minimally invasive techniques in the treatment of this rare entity and rule out that further studies in the field should be performed.

[Oesophageal duplication with neonatal revelation. About 2 cases]

Oesophageal duplication is a rare form of digestive duplication. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. We report 2 cases of oesophageal duplication discovered in the neonatal period.

CASE REPORT

In both cases, symptoms were dominated by respiratory distress and vomiting. Diagnosis was confirmed by oesophageal contrast X-rays, which revealed a total tubular form in the 1st case and a cystic form in the 2nd case.

CONCLUSION

Oesophageal duplication is a rare abnormality of benign nature, which can be revealed in neonatal period by a noisy compression picture. Diagnosis of this anomaly should trigger a search for other digestive duplications, as well as associated malformations, in particular vertebral.

Ileal duplication causing recurrent intussusception

Intestinal duplications are rare congenital lesions that can develop anywhere along the alimentary tract. Symptoms usually appear during the first year of life and are varied. Diagnosis is difficult to achieve, and surgery is required for treatment. Here the case of a 6-month-old male with history of recurrent intussusception is reported. Surgery was indicated, and an ileal duplication was found. Intestinal duplication is discussed based on its epidemiology, clinical presentation, diagnosis, and treatment.

Enteric duplication cyst resembling umbilical cord cyst

We report a case of a neonatal male with a prenatal diagnosis of umbilical cord cyst that was finally diagnosed as an ileal duplication cyst after post-natal surgical exploration of the umbilical mass. To our knowledge, a similar case has never been reported previously. Although this form of presentation of enteric duplication cyst is exceptional, it should be taken into consideration when evaluating suspected umbilical cord cysts.