Conservation approach to duplication of the small bowel

Abstract

Background/Purpose: Intestinal duplication and adjacent small bowel share a single mesentery with straight arteries from the arcade supplying the normal bowel or supplying the duplication. The usual surgical management is resection of the duplication and the adjacent bowel with end to end anastomosis of the remaining bowel. The aim of this study was to conduct an experimental study of blood supply to the bowel and consequences of ligation of the straight arteries to one side of the bowel, and attempt preservation of all normal bowel in patients who have duplication. Methods: The study was carried out on 25 New Zealand white rabbits. The intestinal blood supply of three groups of rabbits (control, acute, and chronic) have been studied by perfusion, microdissection and stereoscopic microscopic examination, and scanning electron microscopy after impregnation with gold, after ligation of the straight arteries to one side of the intestine. From 1992 to 1996, 14 patients who had duplication of the bowel were treated by resection of duplication and conservation of bowel. They have had follow-up for up 4 years. Barium studies have been performed. Results: In the animal studies, the bowel was viable and functioning normally in all animals but numerous adhesions developed. The results presented show no impairment in bowel function in human studies. Conclusion: Ligation of the straight arteries to the duplication with resection of only the duplication is a satisfactory approach to conservation of bowel in patients who have duplication.