Alimentary Tract Duplications Research Articles

True pylorus duplication: a case report

True pylorus duplication cysts are particularly rare, the literature describes only a small number of cases. They account for nearly 2.2% of all alimentary tract duplications. Most of the gastric duplications presents at an age younger than one year with one-third diagnosed in the neonatal period. However, they are not limited to that period. We report a case of a true pyloric duplication cyst in a 3-year-old girl who had been experiencing frequent vomiting with occasional abdominal pain for about 15 days prior to her presentation. The patient had an abdominal ultrasound that showed an epigastric cystic mass. CT of the abdomen demonstrated a 3.8×3.8 cm mass with a claw sign proximal to the first part duodenum. The diagnosis of pyloric duplication cyst was confirmed during the operation and with the histopathological examination following the resection. The patient is doing well with an appropriate weight gain at the follow-up appointments. The patient is doing well with an appropriate weight gain at the follow-up appointments. In summary, this is an an unusual case of gastric outlet obstruction that presented outside the usual age period caused by a pyloric duplication cyst. Imaging studies including US and CT are useful aids in the diagnoses of gastrointestinal duplication cysts.

Video assisted thoracoscopy surgery a viable alternative for duplication cyst excision: a case report on foregut duplication cyst

Alimentary tract duplication is a relatively uncommon congenital abnormality. It can be found anywhere from the mouth to the anus and can be symptomatic or undetectable. Although congenital duplication can happen anywhere in the gastrointestinal tract, the ileum, oesophagus, and colon are the most common locations. The foregut, which includes the stomach, and first and second segments of the duodenum, is the source of one-third of all duplications. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Furthermore, excision through surgery is required for pathological examination of the resected specimen for definitive diagnosis. The most promising surgical approach for cyst excision has been thought to be open surgical resection through a posterolateral thoracotomy incision. However, video assisted thoracoscopy surgery has recently emerged as a viable surgical option for duplication cyst removal In paediatric surgery, video assisted thoracoscopy surgery has been established to facilitate the removal of mediastinal masses. However there is a limitation of research in the literature regarding the best surgical technique for oesophageal duplication cyst excision. In girls, foregut duplication is more common, especially in cases when bronchopulmonary involvement is present. While many duplications result in issues in early development, some are discovered by accident. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Haemoptysis and respiratory distress may be present in specific cases of the patient. Here, we described a 5-year-old male infant's case of foregut duplication with bronchial involvement and its management.

Incidental Finding of “CONGENITAL DUPLICATION OF THE JEJUNUM” in 42 Years Female

Alimentary Tract Duplications (ATD) are congenital anomalies that can arise at any level from the mouth to the anus [3]. They are rare and often found early in life. A minority of cases may remain undiscovered until adulthood when they may give rise to different symptoms, depending on the location. Diagnosis is difficult due to the rarity of this entity. Surgical correction is the treatment of choice.

Tubular intestinal duplication extending from the stomach to the ileum associated with multiple intestinal atresia and situs inversus: a case report

BackgroundDuplication 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 presentationA 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.ConclusionsIdentifying 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.

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

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

Association of gastric duplication cyst with isolated oesophageal atresia and one additional floating rib — A rare presentation

A gastric duplication cyst is not a common anomaly of the alimentary tract. The most common site of alimentary tract duplication is the ileum. We found a non-communicating gastric duplication cyst, along with the greater curvature of the stomach during feeding gastrostomy for isolated Oesophageal atresia. We are reporting a gastric duplication cyst associated with isolated Oesophageal atresia and left side one additional floating rib. This is the third case report of gastric duplication cyst with Oesophageal atresia in English literature.

Gastric Duplication Cyst in 4 Years Male Child: A Rare Case Report

Gastric duplication cyst is an unusual congenital malformation of the gastrointestinal tract representing 4% of all alimentary tract duplications. Clinically the patients may remain asymptomatic or symptoms can be nonspecific, which include abdominal mass, pain, nausea and emesis. We report a four year old male child who presented with intermittent pain in abdomen. The child was evaluated for the same by radiology which suggested a duplication cyst in epigastric region. The child underwent excision for the same following which histopathology confirmed the diagnosis of gastric duplication cyst (Gastric mucosal cyst).

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

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. 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. 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. 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.

Laparoscopic right hemicolectomy for rare case of caecal duplication cyst manifested as intussusception in an adult: a case report

Duplications of the alimentary tract are very rare congenital anomalies, and of which two thirds of cases manifest before the age of two years. Among duplication of alimentary tract colonic duplications are unusual, they may remain asymptomatic and present in adulthood. This report discussed a case of a 26-year-old female who presented with abdominal pain due to colocolic intussusception. Right hemicolectomy was performed for same and the diagnosis of a caecal enterogenous cyst was confirmed by histopathological exam. This report implied that although alimentary tract duplications are rare, they should be considered in any case presenting with abdominal pain. Laparoscopic right hemicolectomy can be performed for good cosmetic results, less morbidity and early recovery.

Robot-Assisted Resection of Intestinal Duplication in Children.

Background: Intestinal duplication is the most common type of alimentary tract duplications in childhood. Laparoscopic-assisted surgery has become the main surgical procedure, but robot-assisted resection has rarely been reported; the aim of this study was to retrospectively present our experience with robot-assisted intestinal duplication excision using the Da Vinci Xi surgical system and discuss the technical points. Methods: In total, 49 patients who were diagnosed with intestinal duplication and underwent surgery from April 2020 to February 2022 in the Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. The data were collected including the clinical information of the patients, operative details, and postoperative outcomes. Results: Among these 49 patients, a total of 15 underwent robot-assisted surgery and 34 underwent laparoscopic-assisted surgery. For the robot-assisted surgery group, all the cysts were peeled off by complete endoscope, the integrity of the intestine was preserved and intestinal resection and anastomosis were not required. The operation time of 80 minutes for the robot-assisted group was not significantly longer than the 90 minutes for the laparoscopic-assisted surgery group(P > .05), but the mean time to take the liquid diet after surgery and the average length of postoperative hospital stay were significantly shorter (P < .05). Conclusion: Robot-assisted resection of intestinal duplication is safe and feasible and the refinement of the Da Vinci Xi surgical system was much better than that of the conventional laparoscopic equipment, resulting in significantly improved intraoperative and postoperative outcomes.

A rectal duplication cyst with rectovaginal fistula: A case report

Alimentary tract duplications (ATD's) are rare congenital anatomical abnormalities. They have an incidence of 1 in 4500 live births and can occur anywhere throughout the digestive tract from the oropharynx to the anus. ATD's occurs most commonly in the midgut (56%), less commonly in the foregut (33%) and even more rare in the hind gut (11%). Rectal duplications are the least common among other alimentary tract duplications, forming only 4% of them. Typically, they are cystic masses, slightly more common in males and they can present in the newborns period or any time later in childhood and even adulthood. We describe a case of an adolescent female presenting with long standing constipation since birth associated with painful defecation and offensive stool odor, abdominal pain and distention. She recently noticed stool in the vagina at the time of defecation. Patient was admitted to our medical center for further investigations and underwent colonoscopy. The study showed two pouches in the rectum, one with blind end and ulcer with suspected fistula opening, and the other lumen continues to the cecum. Abdomen and pelvic CT with rectal contrast was also done, showing a huge recto-sigmoid duplication cyst compressing the native rectum. Evidence of contrast in the vagina was also seen. Decision for surgery was then made. The procedure commenced laparoscopically, showing a huge duplication cyst starting at the distal part of sigmoid and extending downward distally to the rectum. Severe adhesions and edema was also encountered (frozen pelvis) which forced us to convert to open surgery. It was not possible therefore, to perform complete excision of the cyst without risking to damage the rectum and surrounding structures, which will increase the morbidity significantly in our case. Moreover, the fistula was not seen from this approach, as it was very low. We eventually performed a near total cystectomy with the sigmoid attached to it, joined the common wall of the remaining of the cyst and the native rectosigmoid using endo-GIA staplers. We decided to exteriorize the proximal colon as end colostomy. Subsequently, the fistula was taken down trans -vaginally by the gynecology team as a second procedure . A third procedure was performed 6 months later, a laparotomy was performed, the colostomy was taken down and primary anastomosis was performed. No immediate postoperative complications were seen and the patient was discharged in good general condition. This is a unique case as it is a case of a huge rectosigmoidal duplication cyst that was discovered in a female at an adolescent age, causing severe adhesions and chronic inflammations in the pelvis which led to a rectovaginal fistula and made complete resection impossible without converting the surgery into a major surgery with risk of morbidity and long term sequela. As the condition is considered benign, the medical literature is usually against performing a major surgery that can be harmful to the patient like a very low anterior resection to excise the duplication cyst as it is acceptable to perform partial excision with unification the two lumens together which was performed in our case. This case is an example of multistage and multidisciplinary procedure to treat a rare duplication cyst anomaly.

Thoraco-abdominal duplications in children: Two case reports.

IntroductionThoraco-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 caseIt 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 discussionThoraco-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.ConclusionOur 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.

Gastric antral duplication cyst: A case report

Alimentary tract duplications may be symptomatic or may be discovered incidentally. They are named for the organ with which they are associated.1 Congenital gastrointestinal (GI) tract duplication cysts are commonly located in the ileum (53%), mediastinum (18%), colon (13%), stomach (7%), duodenum (6%), rectum (4%), or oesophagus (2%)2. A single theory is insufficient to explain all types of duplications.3 Children may present with symptoms like vomiting, abdominal pain, lumps, or weight loss.4 The presence of ectopic gastric mucosa and the potential for malignancy remain matters of concern.2 Surgical management is essential for these rare cysts.5 We encountered a Bangladeshi boy with a gastric duplication cyst (GDC) that was pre-operatively diagnosed as a pancreatic cyst. A variety of imaging modalities failed to indicate GDC before the operation. Here we present the clinical course of the case and discuss the difficulties and problems in diagnosing GDC.

Atypical presentations of alimentary tract duplications in children: two case reports

Atypical presentations of alimentary tract duplications in children: two case reports

WHAT DO WE KNOW ABOUT ALIMENTARY TRACT DUPLICATIONS IN CATS?

O presente trabalho trata-se de uma revisão de escopo de duplicações de trato gastrointestinal em gatos. Os critérios de inclusão foram determinados pela revisão de relatos de caso de duplicações gastrointestinais confirmadas por exame histopatológico, incluindo-se também neste trabalho um caso de um felino diagnosticado com duplicação cística duodenal em nossa instituição. Treze casos de duplicações gastrointestinais foram analisados, sendo que um animal possuía uma duplicação bifocal, totalizando, portanto, quatorze duplicações. As variáveis consideradas foram idade, sexo, raça, sintomatologia, localização anatômica, morfologia, presença de comunicação luminal, progressão para malignidade e recorrência. Aproximadamente 62% (n=8/13) dos gatos afetados apresentavam entre 4 meses a 2 anos de idade. Não foi observada predisposição quanto ao sexo, enquanto raça e sintomatologia variaram. Duplicações duodenais corresponderam a 36% (n=5/14). Duplicações císticas sem comunicação luminal 93% (n=13/14). Uma duplicação evoluiu para neoplasia e a recorrência de duplicações gastrointestinais entre os gatos foi de 15% (n=2/13). Evolução para obstrução, hemorragias e malignidade já foram descritas em humanos e gatos como consequência de duplicações gastrointestinais. Considerando a importância e o desafio diagnóstico desta afecção, conclui-se que o clínico veterinário de pequenos animais deve considerar as duplicações de aparelho digestivo no diagnóstico diferencial de gatos jovens com vômitos crônicos e massas císticas intestinais.

Alimentary tract duplications in children - a 15 years' experience.

Duplications of the alimentary tract are a diverse and complex spectrum of congenital malformations and can be found anywhere along the digestive tract. The management depends on multiple factors, such as age, location, size, macroscopic aspect, and the associated anomalies. This study reflects a 15-year single surgical team experience. We reviewed medical records of 35 consecutive patients presenting alimentary tract duplications, evaluated and managed between 2004 and 2019. The anatomical distribution included: oral structures (two cases), esophageal (three cases), gastric (three patients), jejunoileal (seven cases), ileocecal (12 cases), colonic (six cases), anorectal (one case), and one case of complex tubular duplication of the terminal ileum and entire colon with two anal openings at the perineum. Four patients had antenatal diagnosis, initially asymptomatic, were followed, after birth, with repeated ultrasound examinations for a medium period of 3.8 months. All cases were managed with open surgery. Excision of the lesion with preservation of the gut integrity could be performed in 28 of the cases, while in six cases, enterectomy followed by digestive anastomosis was required. In one complex caudal duplication syndrome, the duplicated tubular colon was left in place. The postoperative complications were gastroesophageal reflux disease (GERD) (two cases), Claude Bernard–Horner syndrome (one case), wound infection (one case), and in one case, massive tongue edema. Clinical findings may be misleading, imaging studies may be uncertain, therefore the surgeon remains to complete de picture with intraoperative findings. In complex duplication cases, a multidisciplinary approach is imperative for the best results.

Duplications of the alimentary tract in infants and children

Background: Duplications of the alimentary tract are known for their embryonic, anatomical, clinical, and pathologic variations. Summarizing the features of these lesions would reveal these characteristics and guide appropriate management. The objectives of this study are to describe the clinical features and characteristics of all cases of duplication of alimentary tract managed at a tertiary center.Materials and Methods: A retrospective study on all cases of duplications of the alimentary tract managed at a tertiary center from July 2015 to June 2020 (5 years) was conducted after approval from the Institutional Ethics Committee. Data regarding history, demographic details, symptoms, clinical features and investigation results, and intraoperative and histopathologic findings were collected from the hospital records and analyzed.Results: Twenty-eight cases of duplication were managed during this period. They had different locations (esophageal-5 [cervical-2 and thoracic-3], gastric-1, jejunal-3, ileal – 11, cecal-3, appendicular-2, colorectal-1, rectal-1, and posterior anal canal-1) and site-specific symptoms but definite histopathology with evidence of adjacent gastrointestinal tissue on microscopic examination. Unique cases included cervical esophageal duplication, bleeding ileal duplication (ID) with heterotopic mucosa, ID with bezoar, jejunal duplication with malrotation, appendicular duplication with type 2 pouch colon and anorectal malformation, rectal duplication, and posterior anal duplication. Case-specific management ensured minimal complication without any mortality.Conclusion: Variable location and site-specific symptoms necessitate individualized case-specific management of duplication anomalies. Histopathology confirms both native and heterotopic gastrointestinal tissues and is indispensable for the diagnosis.

Intestinal duplication in an elderly-male presented as sigmoid volvulus

Alimentary tract duplications are uncommon congenital anomalies that are often detected in the first decade of life. However, a smaller number of cases may remain unsuspected until adulthood. These anomalies are most common in the ileum and usually present at the bowel's mesenteric border. These can also occur anywhere in the digestive tract. This article reports a case of a 74-year-old male with intestinal duplication arising from the antimesenteric border of the transverse colon, who clinically presented as sigmoid volvulus.

Combined thoraco-laparoscopic surgery for neonatal alimentary tract duplication.

Transdiaphragmatic duplication of digestive tract in infants is very rare. Open surgery is the main surgical treatment. We report the clinical data of a child with gastrointestinal duplication across the diaphragm who underwent thoraco-laparoscopic surgery at 12 days were retrospectively analyzed, and to explore the experience of thoraco-laparoscopic surgery in the treatment of alimentary tract duplication across the diaphragm in children, we believe minimally invasive surgical resection using thoracolaparoscopy is safe, effective and clinically feasible, focusing on the skilled use of the technique to achieve the ideal surgical effect and appearance.

WITHDRAWN: Combined thoraco-laparoscopic surgery for neonatal alimentary tract duplication

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