Bowel Duplication Research Articles

Multi-time point imaging in 99m Tc-pertechnetate scintigraphy of ectopic gastric mucosa in duplication cysts: value-added services.

The aim of our study was to describe the scintigraphic patterns of 99m Tc-pertechnetate uptake in patients who were referred to the department of nuclear medicine for evaluating and diagnosing ectopic gastric mucosa in foregut and midgut duplication cysts. This hospital-based, retrospective cum prospective research spans a period of 8 years from April 2014 to January 2022. Previous hospital medical records were analyzed and subsequently, a database was prepared which included the age, sex, clinical indication of a 99m Tc-pertechnetate scan, and the planar and SPECT-computed tomography (CT) imaging findings. Postoperative histopathological reports were available for 21 patients. Dynamic and planar static imaging was performed. We included SPECT-CT in suspected duplication cysts to increase the sensitivity and specificity which is a tradeoff for a small amount of additional radiation exposure. A total of 69 patients were subjected to a 99m Tc-pertechnetate scan for suspected foregut or midgut duplication cysts. All were subjected to dynamic planar and delayed static images up to 24 h or until focal uptake of radiotracer was noted which corroborated the anatomical findings, whichever was earlier. SPECT-CT was performed along with the planar study in 31 patients which confirmed the findings. Previously performed CT scans were used for anatomical correlation in the remaining ones. Duplication cysts were localized in a total of 28 patients (19 foregut duplication cysts and 12 small bowel duplications - 3 patients had dual duplication cysts, both foregut, and midgut). Forty-one patients had no scintigraphic evidence of ectopic gastric mucosa. Of these 69 patients, histopathological diagnosis was available for 21 patients (22 lesions). The report was concordant with the scan findings in 15 patients (16 lesions) and 6 patients showed discordance in histopathological diagnosis and scan findings. In conclusion, multi-time point imaging is the key to diagnosing ectopic gastric mucosa of various sizes and in various locations. An abnormal radiotracer uptake in dynamic sequences, even before the appearance of the stomach in the region of the small bowel is indicative of intestinal duplication, and delayed radiotracer visualization in the region of the thorax is characteristic of intrathoracic foregut duplication cyst.

Bowel Resection Through a Single Umbilical Incision: A Case Series.

Background: The advent of laparoscopy has revolutionized surgery. The surgeon strives to minimize incisions and their adverse consequences. Although laparoscopy has gained widespread popularity, several advantages in open surgery are thereby lost. Tactile sensation of the tissue, hand-sewn anastomosis, and nonthermic vascular control are most prominent. To combine both approaches, single incision laparoscopic-assisted surgery (SILS) was advanced, trying to combine the best in both worlds. This approach is widely used in appendectomies. After having gained experience in this approach, we expanded the indications and hereby present our experience with bowel resections utilizing SILS. Patients and Methods: Data were collected retrospectively from operations performed during the past 3 years. We found 11 cases of SILS bowel resections: 3 sigmoidectomies, 3 small bowel atresia repairs, 1 subtotal colectomy, 1 Meckel's diverticulectomy, and 3 resections of bowel duplications. The age of the patients ranged from 2 days to 17 years. In all cases, a working 10 mm scope was inserted through the umbilicus, the bowel was extracted outside the abdomen through the umbilicus, dissection and resection with anastomosis were performed outside the abdomen in the classic open approach, and the bowel was returned to the abdomen. Results and Conclusions: All patients recovered promptly with no need for further intervention. There were no cases of wound infection, leak, or intra-abdominal abscess formation. Cosmesis was excellent with a small umbilical scar. We conclude that this approach is feasible and safe in a select population.

Unroofing and argon mucosal remnant ablation of neonatal duodenal duplication cyst

BackgroundDuodenal duplication cyst is an uncommon foregut malformation usually diagnosed at birth or during infancy. Differently from elsewhere, sited small bowel duplications cannot be removed with simple bowel resection, because of the proximity of the biliary and pancreatic ducts also possibly with abnormal course.Case presentationWe report a duodenal duplication cyst in a newborn female requiring early surgery because of nutritional difficulties. The cyst was located adjoined to the second portion of the duodenum sharing part of its muscle wall with the bowel. It was treated by removal of all the esophytic cyst while the remaining mucosa on the common wall with the duodenum was ablated with argon plasma coagulation, preserving the bowel integrity. Early postoperative period was uneventful, and the child could be fed per os on the second day. Yearly follow-up was maintained until 16 years for the risk of recurrence and cancer change due to the incomplete excision. Clinic and echographic controls had always been stayed free from any sequelae.ConclusionsForegut duplications should be removed totally to prevent complications and the long-term risk of cancer, but a duodenal resection can be a harmful surgery in neonatal age. Duplication cysts that are impossible to remove totally can be treated by unroofing and argon plasma coagulation of mucosal surface remnants, avoiding the risks of major procedures also in newborns.

Caudal duplication syndrome: Complete duplication of the hindgut and genitourinary system

Caudal duplication syndrome is a very rare anomaly and poses a major challenge for surgeons. The term caudal duplication syndrome is used to describe the association between hindgut duplication, duplication of the genitourinary, and malformations of the spinal cord and vertebrae. A 5-year-old girl is reported with complete duplication of the entire large bowel, cecum, appendix, about 2 cm of the terminal ileum, bladder, urethra, vagina, uterus, and vertebral body deformities. After an extensive evaluation phase, a laparotomy was performed and the duplicated colon was excised completely without removing the adjacent native colon.

A Rare Neonatal Adnexial Mass Cause: Intrauterine Over Torsion

Ovarian pathologies are rare in intrauterine and
 neonatal period. Teratomas, auto-ovaries or fallopian tubes, mesenteric cysts,
 bowel duplications and ovarian torsions are the most common benign masses.
 However, intrauterine ovarian torsion is a rare clinical condition. In this
 case, will be presented a newborn patient diagnosed with intrauterine ovarian
 torsion, intrauterine period was followed with the diagnosis of teratoma.

Meckel’s diverticulum located at the mesenteric edge of the ileum in an adult male: case report

Meckel’s diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract and occurs in 2-3% of the population. It is a true intestinal diverticulum that results from failure of the vitelline duct to obliterate during the fifth week of fetal development. Very few cases of ileal mesenteric edge location have been reported in the literature. We report a case of a 33 year old male, who presented with clinical signs of localised peritonitis. At laparotomy we found a perforated appendix with localised peritonitis. An incidental finding of a MD was discovered at about 70cms from the ileocecal valve. Macroscopic examination revealed an out pouching growth of 32mm in length, 12mm in diameter with the distal end being slightly bulbous. A segmental resection of the MD with primary anastomosis was performed. The ileal mesenteric edge locations of MD have been reported by a few other authors. The fact that the condition is not reported in large series could contribute to its consideration as bowel duplication. Because there is a high risk of ileal mesenteric MD to erode the mesenteric vasculature and cause devastating consequences, we advocate for systematic resection of ileal mesenteric MD in absence of other contraindications. We believe the ileal mesenteric location is a variant of the classical antimesenteric location. Finding a MD on the ileal mesenteric edge is exceptionally rare.

Adenocarcinoma arising in a small bowel duplication cyst

Adenocarcinoma arising in a small bowel duplication cyst

Laparoscopic Excision of an Ileal Duplication with Intracorporeal Enteroenterostomy in an Infant

Abstract Introduction: A 6-month-old male underwent laparoscopy for resection of a bowel duplication. He initially presented with 2 days of emesis and had imaging performed that was consistent with an ileal duplication cyst. We present a technique of ileal duplication cyst excision with intracorporeal primary bowel anastomosis. Methods: A 5-mm port was placed through the umbilicus and a diagnostic laparoscopy was performed. The duplication cyst was seen in the wall of the distal ileum nearly 20 cm from the terminal ileum. Two additional 5 mm ports were placed in the midline and left flank. The intestine was pexed to the abdominal wall on one side of the cyst to provide adequate observation of the specimen. Two small openings were made in the mesentery on either side of the duplication cyst using hook diathermy. A 5 mm endoscopic stapler was used to divide the proximal and distal bowel. After resecting the cyst, stay sutures were placed on the ends of the remaining bowel and were approximated to one anothe...

Enteric duplication in children: Experience from a tertiary center in South India.

Background:Enteric duplications (EDs) are rare aberrations of the embryonic gut. This study was undertaken to define the clinical characteristics and management challenges of this unusual entity in the Indian population.Materials and Methods:Hospital records of 35 children with 38 ED operated between 2003 and 2014 were analyzed and followed up.Results:The median age at presentation was 285 days (range 1-day to 16 years) with male preponderance (71%). Small bowel duplications were the most common (44%), and thoracoabdominal duplications were seen in 8% children compared to 2% in the literature. The median duration of symptoms was 18 days (interquartile range [IQR] 3-210 days). Associated anomalies were seen in 49% children with vertebral and spinal anomalies being the most common. Ultrasonogram (US) was done in 83% children and had a sensitivity of 55%. In the presence of a gastrointestinal bleed, Technetium99m pertechnetate scintigraphy scan had a positive predictive value of 80%. Thirty-five lesions were completely removed. Mucosectomy was done in two children, and one total colonic duplication was left in situ after providing adequate internal drainage. There was no postoperative mortality. The follow-up was possible in 66% children.Conclusions:EDs are uncommon and have varied, nonspecific symptoms. Thoracoabdominal duplications are more common in the Indian population. The US is a good screening tool but requires a high index of suspicion where complete excision is not possible; the provision of adequate internal drainage is an acceptable alternative. The long-term prognosis of children with ED depends on the extent of physiological disturbance due to associated anomalies.

English

Duplication of bowel represents one of many congenital abnormalities of the gastrointestinal tract. It is a not uncommon cause of acute abdominal pain but remains a consideration in the pediatric population. It is well known that exploratory laparotomy is undertaken in pediatric patients. But in adults it will be difficult to diagnose this as the cause of chronic abdominal pain. We present the case of a patient who was admitted to hospital several times for recurrent abdominal pain in whom we eventually diagnosed intestinal duplication. KEYWORDS: Bowel duplication, Congenital anomaly. CASE REPORT: A 23-year-old man presented to the emergency department at the District Hospital Belgaum, attached to Belgaum Institute of Medical Sciences, Belgaum with a history of acute onset of cramping per umbilical pain and vomiting. His medical history included multiple admissions over a 6- year period for similar symptoms. Physical examination revealed mild abdominal tenderness but no peritonitis. Soon after admission, his acute abdominal pain resolved. An ultra sonological report of abdomen revealed a multiloculated cystic mass, suggesting a mesenteric cyst. In view of chronic pain in the abdomen, we obtained consent for exploratory laparotomy. The procedure revealed an ileal duplication 38-cm long with a cystic dilatation that had adhesions to the transverse colon (Fig.1). The base of the cyst was fibrotic, suggesting that recurrent obstruction at this level resulted in the patient's periodic episodes of abdominal pain. We resected the cyst and the parallel segment of small bowel and conducted a primary anastomosis. The patient had an uneventful postoperative period. DISCUSSION: Gross and colleagues 1 first defined intestinal duplication as spherical or tubular structures that possess a well-developed smooth muscle layer and are lined with a mucous membrane; they are found at any level from tongue to anus and usually are intimately attached to some portion of the alimentary tube. One large study 2 suggests that most duplications are intra- abdominal and of these, ileal and ileocecal duplications are the most common. Clinical presentation is similar to that in our patient's case and includes recurrent abdominal pain, vomiting, abdominal distension, gastrointestinal hemorrhage and sometimes peritonitis if a peptic ulcer perforation occurs in the duplicated segment with ectopic gastric mucosa or in the adjacent normal bowel. 3,4 The duplication can be the lead point in intussusception2,4 or the site of volvulus.2 Pre-natal ultrasound or ultrasound at the time of clinical presentation may lead to the diagnosis of these benign lesions. Differentiation from mesenteric cysts can sometimes be made during that initial ultrasound based on the thinner nature of the intestinal wall. Preoperative diagnosis is more commonly made with intestinal duplications of foregut than of mid gut or hindgut origin. 4 The universally accepted management of this condition is surgical intervention, and the

Gastroesophageal Heterotopia and HER2/neu Overexpression in an Adenocarcinoma Arising From a Small Bowel Duplication

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment.

Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound.

Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.

78 Reversal of Hypermethylation As a Novel Strategy for NSAID Chemoprevention of Colon Carcinogenesis: Potential Role of Dnmt1

BACKGROUND AND AIM: Endoscopy is the first level procedure in the diagnosis of gastrointestinal (GI) masses. However gastro-duodenal or colonic lesions which mainly involve submucosa or subserosa as well as small bowel's lesions may be difficult to diagnose. The present study aimed to evaluate the role of ultrasound (US)-guided percutaneous biopsy in diagnosing GI tract lesions. PATIENTS AND METHODS: 114 patients (63 male 51 female patients, age range 55-80 years, median age 68 years) underwent US-guided biopsy of GI lesions from 2000 to 2012. In 36 patients the lesion was in the small bowel, thus endoscopically inaccessible; in 50 patients previous histology of endoscopic biopsies was repeatedly negative; in 18 patients, stenosis did not allow bioptic sampling and in 10 patients age, severe cardiological disease and sepsis prevented endoscopy. We used multi-frequency convex probes with side adapters and 18G cutting needle for histological sampling. After biopsy, patients were monitored by measuring blood pressure and pulse rate during the following 3-4 hours to evaluate possible complications. Histology was compared with postsurgery histological evaluation in 73 cases. In the remaining, histology of US-guided biopsy was the only clue to diagnosis. RESULTS: Biopsy specimens were taken from stomach in 38 cases, small bowel in 36 cases and colon-sigma in 40 cases. Final diagnosis was malignant lesions in all but three cases. One case was intestinal endometriosis, the second was bowel duplication, whereas in the third case it was a false-negative result, the correct diagnosis being gastric adenocarcinoma. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of biopsy were respectively 99%, 100%, 100%, 66%, 99%.We observed no mortality and one complication: A case of melena due to bleeding from gastric gastrointestinal stromal tumor that was effectively controlled by positioning of metal clips. CONCLUSION: US-guided percutaneous biopsy of GI tract lesions may be an alternative, safe and effective procedure for diagnosis of GI tract lesions in those cases where conventional diagnostic approach is not feasible or successful.

79 Vitamin D Receptor Inactivation Alters the Colonic Microbiome and Increases Secondary Bile Acids and Colonic Tumorigenesis

BACKGROUND AND AIM: Endoscopy is the first level procedure in the diagnosis of gastrointestinal (GI) masses. However gastro-duodenal or colonic lesions which mainly involve submucosa or subserosa as well as small bowel's lesions may be difficult to diagnose. The present study aimed to evaluate the role of ultrasound (US)-guided percutaneous biopsy in diagnosing GI tract lesions. PATIENTS AND METHODS: 114 patients (63 male 51 female patients, age range 55-80 years, median age 68 years) underwent US-guided biopsy of GI lesions from 2000 to 2012. In 36 patients the lesion was in the small bowel, thus endoscopically inaccessible; in 50 patients previous histology of endoscopic biopsies was repeatedly negative; in 18 patients, stenosis did not allow bioptic sampling and in 10 patients age, severe cardiological disease and sepsis prevented endoscopy. We used multi-frequency convex probes with side adapters and 18G cutting needle for histological sampling. After biopsy, patients were monitored by measuring blood pressure and pulse rate during the following 3-4 hours to evaluate possible complications. Histology was compared with postsurgery histological evaluation in 73 cases. In the remaining, histology of US-guided biopsy was the only clue to diagnosis. RESULTS: Biopsy specimens were taken from stomach in 38 cases, small bowel in 36 cases and colon-sigma in 40 cases. Final diagnosis was malignant lesions in all but three cases. One case was intestinal endometriosis, the second was bowel duplication, whereas in the third case it was a false-negative result, the correct diagnosis being gastric adenocarcinoma. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of biopsy were respectively 99%, 100%, 100%, 66%, 99%.We observed no mortality and one complication: A case of melena due to bleeding from gastric gastrointestinal stromal tumor that was effectively controlled by positioning of metal clips. CONCLUSION: US-guided percutaneous biopsy of GI tract lesions may be an alternative, safe and effective procedure for diagnosis of GI tract lesions in those cases where conventional diagnostic approach is not feasible or successful.

Tératome géant du cordon ombilical associé à des malformations fœtales : étude morphologique et cytogénétique

We report on an unusually large teratoma of the umbilical cord associated with multiple fetal anomalies. At 18 WG, an umbilical cord tumour was discovered by ultrasonography in a 38 year-old woman. A 2680 g female neonate (46, XX) was delivered at 37 WG by caesarean section. During surgery for exomphalos, a complete bowel malrotation, ischemic jejunal stenoses and bowel duplication were discovered. The tumor (2515 g) was a teratoma supplied by collaterals of the umbilical vein. Proliferative index calculated by flow cytometry was less than 10%. Tumor karyotype revealed several numerical anomalies with no structural abnormalities using multi-FISH analysis. Immunostaining for CEA and AFP were observed in endodermic derivatives of the duplication and associated with transient high levels of AFP in the blood. To our knowledge, it is the first case to be reported in the literature where karyotype, multi-FISH and FCM studies were available.

Effectiveness of MR Enterography for the Assessment of Small-Bowel Diseases beyond Crohn Disease

The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain.

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel.

Large tubular colonic duplication in an adult treated with a small midline incision

Tubular colonic duplication presenting in adults is rare and difficult to diagnose preoperatively. Only a few cases have been reported in the literature. We report a case of a 29-year-old lady presenting with a long history of chronic constipation, abdominal mass and repeated episodes of abdominal pain. The abdominal-pelvic computed tomography scan showed segmental bowel wall thickening thought to be small bowel, and dilatation with stasis of intraluminal content. The provisional diagnosis was small bowel duplication. She was scheduled for single port laparoscopic resection. However, a T-shaped tubular colonic duplication at sigmoid colon was found intraoperatively. Resection of the large T-shaped tubular colonic duplication containing multiple impacted large fecaloma and primary anastomosis was performed. There was no perioperative complication. We report, herein, the case of a T-shaped tubular colonic duplication at sigmoid colon in an adult who was successfully treated through mini-laparotomy assisted by single port laparoscopic surgery.

Spontaneous Resolution of Small Bowel Obstruction in a Child following Rupture of a Small Bowel Duplication Cyst

Duplication cysts are rare congenital malformations that can present with a variety of symptoms that may change during the course of an acute admission. We report a case in which a four-year-old boy presented with signs of small bowel obstruction that following imaging were found to be secondary to bowel compression by a large duplication cyst. The symptoms changed when the cyst ruptured. We highlight the importance of ultrasound in establishing the diagnosis of enteric duplication cysts in the symptomatic paediatric population. We also explore the differential diagnosis and complications that can be caused by these congenital anomalies.

Single-incision laparoscopic surgery in children: initial single-center experience

BackgroundIn continued efforts to further improve the advantages of minimally invasive surgery to patients, surgeons have developed single-incision laparoscopic techniques. We report our initial experience in children with a variety of single-site procedures. MethodA retrospective chart review was performed on patients who underwent a single-site procedure from April 2009 to April 2010. ResultsThere were 142 consecutive procedures: 24 cholecystectomies, 103 appendectomies for nonperforated appendicitis, 2 splenectomies, 1 combined splenectomy/cholecystectomy, 8 ileocecectomies, 2 Meckel diverticulectomies, 1 small bowel duplication resection, and 1 jejunal stricture resection. There were 12 conversions to conventional laparoscopy: 10 during appendectomy and 2 during cholecystectomy. Mean operative time was 34 minutes for appendectomy, 73 minutes for cholecystectomy, 90 minutes for splenectomy, 116 minutes for combined splenectomy/cholecystectomy, 86 minutes for ileocecectomy, and 43 minutes for the small bowel procedures. The only complications were umbilical surgical site infections after appendectomy in 6 patients. ConclusionThis institution's preliminary experience suggests that single-incision laparoscopic surgery in children has at least comparable outcomes to conventional laparoscopic surgery. However, prospective data are needed to prove that single-incision laparoscopic surgery is superior to conventional laparoscopy.