Alimentary tract duplications in children: case and literature review

Esophageal duplication and congenital esophageal stenosis

Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.

Presentation and Surgical Management of Duodenal Duplication in Adults

Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.

Foregut duplication cyst: an unusual presentation during childhood

Congenital duplications can occur anywhere in the GIT, one third of all duplications are foregut duplications (esophagus, stomach, first and second part of duodenum). Respiratory symptoms are the most common symptoms in foregut duplications, most cases present with respiratory distress which may be present from birth, or symptoms may be insidious with cough, wheeze, or recurrent respiratory infections. We are presenting a 2-year-old boy presenting with cough and fever. Radiological investigation showed left mediastinal mass that was removed by excisional biopsy and revealed an esophageal cyst. Cough with or without fever could be rare presentations for esophageal cyst.

Intestinal duplication in adulthood: A rare entity, difficult to diagnose

Duplications of the alimentary tract (ATD) are rare congenital anomalies often found early in life. They may occur anywhere in the intestinal tract but the ileum is the most frequently affected site. Clinical presentation of ATD in adults is variable and because these lesions occur so infrequently they are rarely suspected. In the present report we describe a case of ileal duplication in a 61-year-old patient with Crohn’s disease. Despite various radiological investigations and medical consultations, the diagnosis was only made on the surgical specimen.

An unusual colonic duplication associated with a foreign body and anemia: a tale of 2 colons

Alimentary tract "duplications" are infrequent and usually present in infancy and childhood. The diagnostic difficulties associated with these congenital anomalies underscore the need for a high level of awareness given the variable spectrum of clinical presentation. We report a child with a colonic duplication who presented with an intestinal foreign body and iron deficiency anemia.

Partial intestinal obstruction secondary to multiple lipomas within jejunal duplication cyst: A case report

Lipoma within jejunal duplication presenting as abdominal bloating and partial intestinal obstruction is an exceptional clinical entity. We report a case of 68-year-old man complaining of abdominal bloating for 10 d due to multiple lipomas arising from jejunal duplication cysts. Only a few cases of a single lipoma within a Meckel’s diverticulum giving rise to this clinical scenario have been reported in the English language literature. However, no case of multiple lipomas within jejunal duplication cysts has been reported. We present a case in which double-balloon endoscopy revealed a small intestinal structure changed into Meckel’s diverticulum-like cavities containing several lipomas. This case highlights intestinal lipoma as an uncommon cause of adult intussusceptions, which should be included in the differential diagnosis of small intestinal obstruction and appropriate examinations should be chosen.

Complete colonic duplication--a case report

Duplications of the entire colon are very rare. An 18-month-old boy presented with symptoms of chronic constipation and was noted with a complete colonic duplication. The presentation and management are discussed.

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.

Evidence of a common pathogenesis for foregut duplications and esophageal atresia with tracheo-esophageal fistula

The pathogenesis of the alimentary tract duplications, including foregut duplications (FgD) remains speculative. The accidental finding of FgD in fetal rats with esophageal atresia and tracheoesophageal fistula (EA-TEF) induced by Adriamycin provided an animal model to investigate a possible relationship between these two entities. Timed-pregnant rats were intraperitoneally injected with Adriamycin (1.75 mg/kg) on gestational Days 6 to 9. Their embryos were harvested by Caesarean section from gestational Days 14 to 21. Forty-six of embryos were processed and serially sectioned in the transverse or sagittal planes. EA-TEF occurred in 43/46 (93%) embryos of which 11 (24%) were found to have an associated FgD located at the level where the esophagus was absent. Six FgDs communicated with the foregut or the trachea. Five noncommunicating FgDs were located between the foregut and the vertebral column. In the control embryo, the notochord was located in the centre of the vertebral column from Day 11 of the gestation. In Day 14, 15 and 16, however, embryos exposed to Adriamycin, an abnormal notochord or branch frequently was located within the mesenchyme of the maldeveloped foregut or attached to the duplication cyst. In some, it appeared that the notochord was drawing the cyst-like structure away from the foregut. The present study confirms that duplications adjacent to the esophagus arise from the foregut and that failure of the foregut to detach from the notochord at the normal time may contribute to the development of foregut duplications.

Perforated Meckel's diverticulum presenting as subphrenic abscess

Meckel's diverticulum is known to present with myriad complications. However, its perforation followed by development of subphrenic abscess has not been reported in literature. We report this complication in an eleven-month-old child.

Gastric duplication cyst. Scintigraphy and correlative imaging

Gastric duplication cysts are uncommon congenital anomalies, and examples imaged with scintigraphy are rarely reported in the literature. The authors report an infant with duplication of the stomach, which was extensively evaluated using scintigraphy, ultrasound, computed tomography, and upper gastrointestinal series. The role of multimodality imaging is discussed, and correlative surgical and histologic findings are presented.

Intestinal obstruction caused by duplication of the caecum

Two cases of caecal duplication are presented, one in a neonate and one in an infant. The diagnosis was made at laparotomy, which had been undertaken for the presumptive diagnosis of intestinal atresia and torsion of an ovarian cyst respectively. Also the literature on alimentary tract duplications is reviewed, referring to the incidence, presenting symptoms, and location of the duplication, in particular that of the caecum.

Bleeding esophageal duplication detected in utero

Peptic complications in duplications of the alimentary tract may occur when the duplication is lined by gastric mucosa. These complications commonly develop in the first year of life. We report a case of a bleeding esophageal duplication in a fetus.

Complex colon duplication mimicking an obstructed, non-functioning kidney in a newborn with imperforate anus and spinal dysraphism

Gastrointestinal (GI) duplications contain tissue resembling several portions of the GI tract and are associated with vertebral and genitourinary (GU) abnormalities [1-4]. We report a newborn with low, imperforate anus and lumbosacral dysraphism, who presented with a large cystic mass in the left renal fossa and pelvis. The flank mass (felt initially to be a dysplastic kidney and ureter) proved to be a complex GI duplication with histologic evidence of gastric, small bowel, and colonic mucosa, as well as respiratory epithelium and pancreatic tissue.

Foregut duplication cyst presenting as neonatal respiratory distress and haemoptysis

The case history is described of an infant, with a thoracic foregut duplication cyst containing a perforated peptic ulcer, who presented with haemoptysis and respiratory distress. This presentation is discussed within the context of thoracic foregut duplications.

Double-barrelled tubular duplication of the ileum

A three year old boy with a 10 cm double-barrelled tubular duplication of the distal ileum is reported. He presented with a small bowel obstruction after a large meal of mandarin oranges. At laparotomy an obstruction of both lumens was found which communicated at both ends with the normal ileal lumen. Although cystic duplications of the small intestine are common, tubular duplications are relatively rare, especially an obstruction with impacted undigested foods.

Tubular communicating duplications of esophagus and stomach

A child with vertebral anomalies and tubular communicating duplications of the esophagus and stomach had a post-natal ultrasound interpreted as normal. This complex anomaly was delineated by barium studies and surgically confirmed.