Intestinal Duplication Research Articles

Hepatobiliary and pancreatic: Torsion of an accessory spleen

A 24-year-old man was investigated because of a 3-day history of epigastric pain that was accompanied by nausea and vomiting. Blood tests revealed an elevated white cell count (13.2 × 109/l) and a mild elevation of erythrocyte sedimentation rate (27 mm/hr) and C-reactive protein (18 mg/dl). An ultrasound (US) study revealed a homogeneous hypoechoic mass in the left upper abdomen with an internal tubular anechoic structure. The tubular structure was thought to be a blood vessel but there was no blood flow on a Doppler study. A contrast-enhanced computed tomography (CT) scan showed an ovoid mass, 8 cm in diameter, in the left upper abdomen that was adjacent to the anterior aspect of the distal transverse colon (Figure 1). The mass was clearly separate from a normal spleen, left kidney and left adrenal gland. The mass did not show contrast-enhancement apart from a small wedge-shaped area in the left lateral portion. There was also a whirled tubular structure adjacent to the mass (arrow). At laparotomy, he had a violet, oval tumor under the omentum. The tumor had a twisted vascular pedicle attached to the splenic pedicle. The resected specimen is shown in Figure 2 and pathologic examination confirmed torsion and hemorrhagic infarction of an accessory spleen. In the developing embryo, the spleen arises from several small mesodermal buds in the dorsal mesogastrium. These normally coalesce to form a single organ. However, failure of coalescence can result in the formation of one or more accessory spleens. These can be identified on an US or CT scan in approximately 3%–4% of patients. However, at postmortem examination, the frequency of accessory spleens ranges from 10%–30%. The most common sites for accessory spleens are the splenic hilum, the gastrosplenic ligament and the tail of the pancreas. Most accessory spleens are asymptomatic. However, torsion may occur as described above and hyperplasia can develop after splenectomy. The latter may be clinically significant if splenectomy is performed for hematological disorders such as hereditary spherocytosis and idiopathic thrombocytopenic purpura. On contrast-enhanced CT, the differential diagnosis of torsion of an accessory spleen can include hemorrhagic complications of cysts such as mesenteric cysts, intestinal duplication and pancreatic pseudocysts.

Caudal duplication syndrome with unilateral hypoplasia of the pelvis and lower limb and ventriculoseptal heart defect in a mother and features of VATER association in her child

We report the case of a 22-year-old female with caudal duplication syndrome, who in addition to intestinal duplication, imperforate anus, a dydelphic uterus and a single kidney also had a ventricular septal defect and hypoplasia of the left pelvis, leg, labia majora and left side of a duplicated vagina. She gave birth to a male baby with features of the VATER association including a tracheooesophageal fistula, a ventriculoseptal defect, an atrial septal defect and mild hypospadias. We suggest that caudal duplication syndrome and the VATER association may overlap and our two cases suggest possible autosomal dominant inheritance.

Duplicación intestinal: Diagnóstico y tratamiento de una condición inusual

Intestinal duplication: Diagnosis and treatment of an unusual condition We report a 2.5 years old male presenting with abdominal pain, nausea and vomiting lasting 30 days. A CAT scan showed an intestinal duplication cyst. The patient was operated and a cystic lesion of 6 cm diameter was fond and excised along with five cm of terminal ileum. Intestinal transit was reconstituted with a terminal anastomosis between ileum and colon.

Detection of ectopic gastric mucosa using 99mTc pertechnetate: review of the literature

Technetium-99m ((99m)Tc) pertechnetate scintigraphy in a child with acute gastrointestinal bleeding of unknown origin suggests ectopic gastric mucosa caused by Meckel's diverticulum or gastrointestinal duplication cysts. Our objective was to define the patterns of scintigraphic findings likely to be encountered in patients with ectopic gastric mucosa with illustrative cases and to review the literature. Fifty children (age 1 year to 14 years) were evaluated for ectopic gastric mucosa using (99m)Tc pertechnetate scintigraphy. Functioning ectopic gastric mucosa was detected in eight patients with Meckel's diverticula and three patients with bowel duplication. Three patients showed atypical findings on scintigraphy which were perforated appendix, calyceal stasis, and regional enteritis. Ectopic functioning gastric mucosa in Meckel's diverticulum is visualized simultaneously with the stomach, whereas in intestinal duplications tracer activity can be visualized in the dynamic sequence or before gastric tracer visualization in an irregular pattern. A variety of scintigraphic patterns can be found in patients with ectopic gastric mucosa undergoing (99m)Tc pertechnetate scintigraphy depending on the location and size of the ectopic tissue. Also, acquisition of delayed images is useful when the initial images are equivocal in children.

Detection of Double Cystic Intestinal Duplication by Meckel's Scan

Detection of Double Cystic Intestinal Duplication by Meckel's Scan

Coincident Occurrence of Intestinal Duplication Cyst and Type I and Type II Intestinal Atresias

The association of intestinal duplication and intestinal atresia is very rare. A case of intestinal duplication associated with Type Ⅰ and Type Ⅱ intestinal atresias is reported, and the relevant literature pertaining to the causation of these lesions is discussed. To the best of our knowledge, this case seems to be the first report in Korean literatures.

Versatility of the circumumbilical incision in neonatal surgery

Following the advent of laparoscopic surgery, cosmesis has become an important factor in surgical decision making. The circumumbilical incision combines the advantages of an open approach with an aesthetically pleasing scar on the abdomen. The aim of this paper is to examine the results of this incision in neonatal laparotomy. All neonates who underwent a supraumbilical circumferential skin incision for an exploratory laparotomy in the period 1997-2007 were reviewed. Gestational age, operative procedure, conversions to standard laparotomy, complications and follow-up were recorded. A total of 55 neonates with a gestational age ranging from 28 to 42 weeks had 57 operative procedures. The indications were: nonrotation of midgut in 18; intestinal atresia in 18; necrotizing enterocolitis/spontaneous perforation in 10; meconium ileus in 5; intestinal duplication in 2; patent vitellointestinal duct (VID) in 2. No conversion to a standard transverse incision was necessary in any case. However, an omega extension was made in four patients. The complications encountered include wound infection in one; caecal perforation in one and incisional hernia in two cases. Subsequent follow-up revealed that all incisions had healed and the scars were almost imperceptible as affirmed by parental satisfaction during outpatient clinic consultation. The circumumbilical approach is a safe, flexible and easily reproducible approach providing adequate exposure for most abdominal surgeries in the neonate. The low complication rate and pleasing aesthetic outcome are much appreciated by parents and operators alike.

Letters to the Editor

Letters to the Editor

Experience with a New Energy Source for Tissue Fusion in Pediatric Patients

Options for effective techniques for vessel and tissue sealing in infants and children are limited because of the size and limited intracorporeal space of many pediatric patients. We evaluated a new energy source, the ForceTriad (Covidien, West Windsor, NJ) LigaSure, which delivers both mono- and bipolar energy in a 5-mm format and allows for tissue fusion and vessel sealing and division. This report documents our experience with this device. A database review was performed, looking for all cases that were performed in children using the ForceTriad LigaSure as the main source of hemostasis and tissue fusion. Two different handpieces were used a fine Maryland dissector-type instrument with no cutting blade, and a sealer/cutter, both in a 5-mm format. A total of 60 cases were performed in children from September 2006 to September 2007, using the ForceTriad. The two most common cases were Nissen fundoplication (40 cases; weight: 8.5-95 kg [average,40.7]; operating room [OR] time: 15-70 min [average, 32]; average days to full feeds: 2) and lung lobectomy (11)cases (weight: 4.6-63 kg [average, 27.3]; OR time: 60-180 min [average, 123]; average hospital days: 3.1). Other procedures included, excision of choledochal cyst (3), aortopexy, closure of bronchopleural fistula, nephrectomy(1), thymectomy (1), parathyroid adenoma excision (1), total colectomy (2), and intestinal duplication resection(2). There were no failures of vessel or tissue fusion and no operative complications. A delayed hydropneumothorax developed in 1 lung resection and spontaneously resolved. The ForceTriad provides a safe, effective energy source in a 5-mm format. As compared to previous versions of the LigaSure, there was less sticking, a quicker seal, and no tissue-fusion failures.

Intestinal duplication in an adult patient diagnosed by multidetector computed tomography enteroclysis: report of a case

This study reports a case of small-bowel duplication, a rare congenital malformation, in an adult with abdominal pain and sub-obstruction signs. CT enteroclysis allowed the diagnosis that conventional imaging failed to demonstrate and it confirmed itself the most accurate exam in small-bowel disease diagnosis. This is the first report of a small-bowel duplication diagnosed by CT enteroclysis.

Lipoma as a Pathological Lead Point in a Child With Ileocolic Intussusception

Lipoma as a Pathological Lead Point in a Child With Ileocolic Intussusception

Adenocarcinoma Arising in an Elderly Patient’s Large Ileal Duplication

Bowel duplications are rare congenital anomalies commonly found in pediatric patients; few cases may remain undetected until adulthood. Malignant carcinomatous changes are rare complications in intestinal duplications. An 88-year-old female patient was referred to our surgical unit with the diagnosis of a large abdominal mass. An explorative laparotomy was performed, revealing a large (22 × 11 cm) neoplasm strictly connected to the lowest ileal segment and completely filling the pelvis. Definitive histology revealed a moderately differentiated adenocarcinoma developing in a duplication of the terminal ileum. The hypothesis of a gastrointestinal duplication should be evaluated in the differential diagnosis of large, complex, indeterminate masses located in or near the bowel; the possibility of neoplasm within the duplication should be considered.

Segmental dilatation of the ileum accompanying hypoproteinemia

Purpose Segmental intestinal dilatation (SID) is a rare pathologic finding, which causes intestinal obstruction in newborn period and gastrointestinal bleeding, anemia, abdominal pain, malabsorption, and growth failure in older children. We present a case of SID causing hypoproteinemia. Patient A 10-year-old girl presented with recurrent abdominal distension since she was 8.5 months old. She was diagnosed to have protein-losing intestinal lymphangiectasia. Result of physical examination was normal except moderate growth retardation. Her blood workup showed depletion in total protein, albumin, and globulin levels. Gastrointestinal series revealed a dilated segment of small intestine, and Tc 99m-pertechnetate scintigraphy detected ectopic activity in abdomen. The patient was taken to operation with the presumptive diagnosis of intestinal duplication. A dilated segment of ileum was encountered, and segmental resection and anastomosis were performed. Results Patient was discharged on the postoperative fourth day and remains well. Histopathologic examination of the specimen revealed SID. Discussion Segmental intestinal dilatation is an uncommon congenital anomaly. Most of the cases were operated on in newborn period because of intestinal obstruction, and their diagnoses were made perioperatively; the others were diagnosed in older ages during the investigation of nonspecific symptoms. The index patient is the second case of SID having hypoproteinemia in the literature. Gastrointestinal series suggested the diagnosis, and segmental resection and anastomosis were the adequate treatments.

Intestinal Duplication Mimicking Meckel Diverticulum

Acute gastrointestinal (GI) bleeding is often intermittent and the bleeding source may be difficult to locate, resulting in delay of potentially life-saving treatment. Technetium-99m pertechnetate scintigraphy is the imaging study of choice for evaluating children with GI bleeding in whom a Meckel diverticulum is suspected. Ectopic gastric mucosa may be found in duplication cysts, gastro- genic cysts, and intestinal duplication giving rise to false positive interpretation. We present an infant with lower GI bleeding who was being investigated for Meckel diverticulum and found to have intestinal duplication.

Multiple Cystic Intestinal Duplications in a Cat

A 7-year-old, female European shorthair cat with a history of recurrent vomiting had a 2-cm cystic mass in the midjejunum. Cross-sectioning and histology revealed 3 separate cystic structures in the muscular layer, in addition to a regularly structured intestinal lumen. One cyst had a 3-layered wall consisting of a dysplastic mucosa, a regularly structured submucosa, and partly double-layered muscularis that sporadically contained neurons resembling a myenteric plexus. The remaining 2 cysts had similar structures except for granulation tissue lining the lumen. The lesion was diagnosed as multiple cystic duplications in the midjejunum, which is unknown to the veterinary literature to date.

165. Intestinal Duplication As a Result of Inactivation of Wnt5a

Introduction: Wnt signaling is known to be critical in anterior-posterior axis patterning and later organogenesis. It has also emerged as a major regulator of stem cell survival, proliferation, and differentiation. Wnt5a is expressed in a gradient at the caudal end of the embryo during gastrulation. Wnt5a knockout mice exhibit defects in many outgrowing structures including the face, limbs, tail, and external genitalia. To date, the role of Wnt5a in gut development has not yet been established. We hypothesized that inactivation of Wnt5a would lead to severe defects in the gastrointestinal tract.

Colonic duplication in an adult mimicking a tumor of pancreas

Duplications of the alimentary tract are uncommon congenital malformations that can present diagnostic difficulties. We report a rare case of a cystic colonic duplication in a female adult. Preoperative investigations were suggestive of pancreatic tumor. The diagnosis was established based on the histopathological examination of the resected specimen. We concluded that, though uncommon, intestinal duplication should be considered in differential diagnosis of abdominal mass.

P-292 A case of recurring bilious vomiting caused by infantile intestinal duplication(Poster Presentation Small intestine 2,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-292 A case of recurring bilious vomiting caused by infantile intestinal duplication(Poster Presentation Small intestine 2,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-116 Case report of intestinal duplication which causes intussusception(Poster Session Intussusception 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-116 Case report of intestinal duplication which causes intussusception(Poster Session Intussusception 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Multiple Intraabdominal Cysts Could Be A Duplication Of Intestine: A Case Report And Treatment Protocol

Duplication of intestine is uncommon with varied presentation. We report an 8-month-old male baby with multiple intraabdominal cysts. On exploration, there were multiple cystic duplications of terminal ileum and ascending colon. Surgery was done successfully. Different types of duplication cysts, their presentation & treatment protocol are discussed.