Segmental Intestinal Resection Research Articles

Meckel's Diverticulitis: About 5 Pediatric Observations Collected at the Nianankoro FOMBA Hospital in Ségou, Mali

Meckel's diverticulitis or meckelitis is the infection of the Meckel's diverticulum. The aim of this work was to study the epidemiological, diagnostic, therapeutic and evolutionary aspects in the pediatric surgery department of the Nianankoro FOMBA hospital in Ségou, Mali. This was a retrospective study concerning observations between July 2010 and June 2012. We reported 5 observations in 2 years, representing a frequency of 2.5 cases per year. The average age was 6.6 years and the sex ratio was 1.5. Diagnostically, abdominal pain was the main reason for consultation followed by fever and vomiting. Physical examination found in all cases abdominal pain more or less associated with guarding in the right iliac fossa and peri-umbilical area. Abdominal bloating and contracture were noted in one case. There was hyperleukocytosis in all our 5 observations. The diagnosis was an operative discovery in 4 cases. Ultrasound was contributory in one case. Therapeutically, segmental resection of the small intestine removing the diverticulum, followed by immediate end-to-end anastomosis of the small intestine was the only technique performed in all our patients. The postoperative course was simple in 4 cases. A wall abscess with a favorable outcome was noted. Histological examination confirmed meckelitis at different stages (inflammatory, abscessed, gangrenous or necrotic). Gastric heterotopia was noted in one observation.

The damages of processus vermicularis and Meckel’s diverticulum in gun–shoot abdominal woundings

Objective. Determination of the damages peculiarities in processus vermicularis and Meckel’s diverticulum in a gun–shot abdominal woundings and tactics of their surgical treatment.
 Materials and methods. Analysis of the gun–shot abdominal woundings has been witnessed the presence of isolated and combined damages of processus vermicularis and Meckel’s diverticulum in 0.18 and 0.06% patients, accordingly. All the wounded persons were the men, their average age have constituted (32±0.3) yrs old. The shrapnel woundings have occurred in 92.4% patients, and the bullet – in 7.6%. Damages of the processus vermicularis base have dominated in its descendent localization, the damages of processus vermicularis and Meckel’s diverticulum were combined with such intestinal affections.
 Results. All the damages of Meckel’s diverticulum and processus vermicularis were revealed intraoperatively. All the hospitalized patients have had the pain syndrome, the peritonitis signs and free liquid in a small pelvis. Surgical tactics consisted of resection of processus vermicularis (in 2 patients using laparoscopic approach), and in the Meckel’s diverticulum woundings the operative intervention volume have included a wedge–like resection of the small intestine part with diverticulum or segmental intestinal resection with formation of the side to side ileo–ileoanastomosis.
 Conclusion. The damages of processus vermicularis and Meckel’s diverticulum constitute a rare combat woundings, which occurs in combined intestinal trauma, what constitute the need for its detailed intraoperative revision. Operative tactics in damages of processus vermicularis and Meckel’s diverticulum constitutes their resection and restoration of intestinal integrity and may be realized through laparoscopic access.

Small bowel segment with Meckel’s diverticulum volvulus related to short mesodiverticular band: a case report

BackgroundMeckel’s diverticulum is a remnant of the omphalomesenteric duct and occurs in only about 2% of people. Mesodiverticular band is the congenital remnant of the vitelline artery and is an even less often occurring phenomenon.Presented caseWe present the case of a 56-year-old Caucasian male who was admitted to the emergency department with a very intense, sudden abdominal pain, without past abdominal surgery history. Contrast enhanced computed tomography showed a possibly ischemic closed loop of the small intestine. Urgent laparotomy was performed, during which bloody content in the peritoneal cavity and torsed loop of the small intestine with Meckel’s diverticulum were found. The bowel loop and Meckel’s diverticulum were ischemic. At the tip of Meckel’s diverticulum there was a broken fibrous band extending to mesentery with pulsating artery. We did segmental resection of small intestine including Meckel’s diverticulum and primary end-to-end anastomosis. The patient had an unremarkable postoperative hospital stay and was discharged home after 5 days.ConclusionIn our case, we describe a patient with the volvulus of a segment of small bowel and Meckel’s diverticulum, which eventually led to small bowel obstruction and ischemia. It was a very rare case that required urgent surgical treatment.

An Unknown Complication of a Rare Combination of Intestinal Invagination and Meckel’s Diverticulum Invaginated in An Adult: A Case Report

Introduction: Intestinal invagination is a common pathology amongst children, while it is a rare entity in adults. Invagination is responsible for only 1-3% of adult-onset intestinal obstruction. Meckel’s diverticulum, on the other hand, is the most common congenital anomaly of the gastrointestinal tract. Most of them are asymptomatic; they are recognized when they complicate, and can present with diverticulitis, gastrointestinal bleeding, intestinal obstruction, perforation, or invagination. Invagination with the Meckel’s diverticulum (MD) is a rare cause of chronic abdominal pain in the adults. We wish to present this first case of intestinal invagination and Meckel ‘s diverticulum invaginated. Presentation of case: We report the case of a 17-year-old man who was admitted to the emergency room due to a diffuse abdominal pain. Abdominal CT scan showed intestinal invagination and intestinal obstruction. The exploratory laparoscopy revealed the presence of intestinal invagination and segmental resection of the small intestine was performed. The patient was discharged on the sixteen post-operative day. Discussion: The prevalence of MD is 1 to 4%. Diagnosis is often difficult and delayed because clinical symptoms are not specific and the diagnosis is performed mainly by imaging studies. Intestinal obstruction is a more common complication in adults, whereas in children, bleeding is the more common complication. In our case, the patient had a diffuse abdominal pain with small bowel obstruction. Laparoscopy may be useful for confirming the presence of intestinal invagination, and demonstrating the underlying organic lesion serving as the lead point. Only with the laparotomy we have been able to notice the combination of intestinal invagination and MD invaginated. Conclusion: we aimed to present the role of Meckel’s diverticulum as an initiating factor of illegible invagination, with inversion into the ileum and specifically in our clinical case can cause invagination of itself.

Jejunum cavernous haemangioma - A rare cause of gastrointestinal bleeding.

We report a case of a 69-year-old male patient with gastrointestinal bleeding manifesting with melaena. Upper and lower endoscopy were negative for the bleeding aetiology. On small bowel capsule endoscopy, several violaceous lesions in the proximal jejunum were identified. The patient was submitted to segmental intestinal resection being diagnosed with a cavernous jejunum haemangioma, a rare cause of acute intestinal bleeding.

Intussusception causing bowel obstruction in a child due to ectopic pancreas: A rare case report and literature review

Introduction: Ectopic pancreas is a congenital anomaly in which the pancreatic tissue is located abnormally, lacking anatomical continuity with the main pancreas. This is not an uncommon anomaly, however the preoperative diagnosis is difficult and the majority of cases are diagnosed histologically after surgery. Ectopic pancreas is commonly found in the upper gastrointestinal tract (including stomach, duodenum and jejunum); rarer in the ileum. The main symptoms of ectopic pancreas in children include gastrointestinal bleeding, vomiting, recurrent abdominal pain, and intussusception. In this article, we report a case of a 4-year-old girl who was diagnosed with ectopic pancreas causing intussusception complicated by bowel obstruction. The patient was treated by laparotomy and recovered uneventfully. Case report: 4-year-old girl with a history of recurrent intussusception admitted with abdominal pain and vomiting. Abdominal ultrasound and computed tomography showed an intussusception complicated by bowel obstruction. The child underwent laparotomy with segmental intestinal resection and was diagnosed with intussusception due to ectopic pancreatic tissue in the ileal wall based on histopathological findings. After surgery, the child recovered uneventfully. Conclusion: Ectopic pancreas is common in the gastrointestinal tract, difficult to diagnose by imaging modalities. Most of cases are diagnosed histologically after sugery. Imaging methods, particularly abdominal ultrasound and computed tomography, play an important role in diagnosing the complications of ectopic pancreas such as intussusception and bowel obstruction. Key words: ectopic pancreas, recurrent intussusception, bowel obstruction

Management of Nonocclusive Mesenteric Ischemia in Patients with Cardiac Failure.

This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI). This research contains all patients diagnosed with congestive heart failure and NOMI between January 2011 to January 2020. The patients who had angiography or CT that showed occlusion of more than 50% in any of the main branches of the mesenteric artery or patients who presented with symptoms in correlation with a total occlusion were excluded from the study. Patients who underwent coronary heart surgery but were not diagnosed with congestive heart failure and those with atrial fibrillation also were excluded from the study. Patients divided into two groups, according to a medical database. A significant difference was found between the surviving and non-survivor groups in minutes, in terms of median time to segmenter intestinal resection (P = 0.042). An early diagnosis and surgical segmental intestinal resection before peritonitis worsens can be the key to better prognosis for NOMI patients.

Laparoscopic surgery of intra-abdominal lymphatic malformation in children.

Lymphatic malformation (LM) in the abdomen is uncommon in children, and the standard treatment is surgical excision. The present study aimed to evaluate the safety and efficacy of laparoscopic surgery of intra-abdominal LM in a pediatric population. The medical records of 10 children with intra-abdominal LM treated by laparoscopic resection from March 2017 to June 2021 in The Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively reviewed. Equal numbers of female and male patients were included and underwent surgery at the median age of 55 months (range, 40 days-94 months). Abdominal pain was the most frequent symptom presenting in eight patients (80%). All children were referral patients, and half of them presented to the emergency department with acute abdominal pain. All 10 of the patients benefited from laparoscopic treatment; three patients underwent extraperitoneal segmental intestinal resection and anastomosis via an enlarged umbilical incision, and two patients were converted to laparotomy because of a large retroperitoneal LM with involvement of the colon. No recurrence or complications occurred in the patients during the follow-up period with mean of 35 months (range, 11-60 months) after surgery. Overall, laparoscopic resection of intra-abdominal LM was an effective, minimally invasive therapy in the pediatric population. Segmental intestinal resection is usually required to achieve the complete removal of lesions to lessen the risk for recurrence.

Mesenteric lymphangioma – a rare tumor of the abdomen

Mesenteric lymphangioma (ML) is a cystic tumor developed at the base of the mesentery, which occurs frequently in children, rarely in adults, with nonspecific symptoms, often diagnosed late. The diagnosis is made by computer tomography and the curative treatment is the surgical one with good results and with optimal postoperative outcome. A 44-year-old patient for whom mesh surgery for incisional hernia post appendectomy has been performed was admitted to our clinic for nonspecific gastrointestinal symptoms for which he has also been investigated multiple times in other services. On the right flank and iliac fossa, a tumor of firmelastic consistency is detected, relatively well delimited. Computed tomography (CT) describes the lesion as a mesenteric tumor. Intraoperatively, a cystic tumor is detected, which is punctured, the biochemical result highlighting the lymphatic character. The surgical treatment was represented by segmental intestinal resection with entero-enteroanastomosis. No postoperative events were reported.

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report.

Intussusception in adults is rare, and the clinical symptoms of intussusception are subtle, making the diagnosis quite challenging. Gastrointestinal lipomas are rare benign tumors and are essentially adipose growths, most frequently found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity, and the diagnosis of duodenal lipoma mainly depends on endoscopy examination, supplemented by computed tomography and magnetic resonance imaging. The present report describes a case of jejunal intussusception in an adult with a history of intermittent colicky abdominal pain located in the left upper quadrant over the last month. Contrast-enhanced computed tomography of the abdomen showed the typical target sign of a small intestinal intussusception along the left upper quadrant and a well-defined, low-density tumor in the intussusception. Exploratory laparotomy revealed jejuno-jejunal intussusception secondary to a lipoma, which was successfully treated with segmental intestinal resection.

Inflammatory fibroid polyp causing ileo-ileal intussusception.

Inflammatory fibroid polyp (IFP) or Vanek´s tumor is a rare and idiopathic pseudotumor arising from the submucosa of the gastrointestinal tract. The underlying cause of IFP remains unclear. Many factors have been incriminated such as intestinal trauma or eosinophilic gastroenteritis. Small bowel involvement is the second most common location of IFP after the stomach. Intestinal IFP is most often revealed by intussusception or obstruction. The mainstay treatment is surgical, which consisted of a segmental intestinal resection. The histological appearance may be a differential diagnosis with other spindle cell lesions, especially with stromal tumors. The definitive diagnosis is confirmed by immunochemistry examination. Herein, we report the clinical case of a 62-year-old female, with no notable medical history, who presented with nausea and vomiting associated with abdominal acute pain and distension evolving for about seven days. The physical examination showed a heart rate of 90 beats per minute, blood pressure of 120/70 mmHg, and body temperature of 37.5°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. Computed tomography (CT) scan of the abdomen revealed dilated small bowel loops proximally of an ileo-ileal intussusception. The wall of the invaginated loop shows an irregular, symmetrical, and short parietal thickening, enhanced after contrast and measuring 36 x 24 mm. The patient underwent an urgent midline laparotomy. Surgical exploration revealed an ileo-ileal intussusception, localized at 70 cm proximal to the ileocecal valve and causing dilatation in the intestine proximal to the intussusception. Manual disinvagination revealed intraluminal polypoid mass (star) obstructing the lumen with parietal umbilication. Segmental resection of the intussuscepted ileum and side-to-side stapler ileal anastomosis were performed. The patient had an uneventful recovery. Histological findings showed bland spindled cells, small vessels, and eosinophil-rich mixed inflammatory infiltrates. Immunohistochemical staining was positive for CD34 and negative for CD 117, DOG1 and S-100 protein. Therefore, a final diagnosis of an inflammatory fibroid polyp was made.

Multiple Jejunal Diverticulosis Complicated by Perforation: Case Report and a Brief Literature Review

Abstract Background Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary.

Isolated ectopic jejunal varices in a patient with extrahepatic portal vein obstruction – A case report

Introduction and importanceAmong the various causes for lower gastrointestinal bleeding, ectopic varices constitute a small chunk. Though rare, these can pose a diagnostic challenge with recurrent bleed leading to multiple admission and blood transfusions.Case presentationA 41-year-old male presented to our department with multiple episodes of melena. On further evaluation with CT angiography, a diagnosis of extrahepatic portal vein obstruction with moderate splenomegaly and ectopic jejunal varix was made. He underwent splenectomy with resection of involved jejunal segment with side to side anastomosis.Clinical discussionThe diagnosis of ectopic varices remains elusive in a large number of cases in view of the varied etiology. Various newer endoscopic and imaging modalities can play a diagnostic as well as therapeutic role but this also further complicates the management as there is a lack of substantial guidelines directing the treatment protocol. As a result, we have to resort to a case by case approach for the optimal management in these cases.ConclusionThe main modality of management for bleeding ectopic varices is percutaneous or endoscopic. Surgery is reserved for refractory cases, with decompressive shunts combined with segmental resection of involved intestine being at the forefront of surgical options.

Chylous content might determine the optimal surgical approach for mesenteric lymphatic malformations in childhood

BackgroundMesenteric lymphatic malformations (LMs) represent rare congenital anomalies that can include chylous or nonchylous content. The pathologic mechanisms explaining this phenomenon are poorly understood and not yet described. Furthermore, the current management approach does not consider the contents of the mesenteric LMs. In the present study, we have defined the relationship between the lymphatic mesenteric cyst content and the histologic evidence of LMs within the bowel wall. MethodsWe retrospectively investigated all patients with mesenteric LMs treated surgically at our department from 1999 to 2018. ResultsA total of 11 patients (6 girls and 5 boys) were included in our analysis. Seven patients had presented with LMs located in the jejunal mesentery, three in the ileocecal region, and only one in the mesocolon transversum and omentum. Of the 11 children, 7 had had LMs with nonchylous content and 4 had presented with chylous content LMs. Intestinal resection was performed in all 4 patients with chylous content LMs and 4 patients with nonchylous content LMs. Histopathologic evaluation of the surgical specimens determined that only the LMs with chylous content displayed malformed lymphatic channels throughout the bowel wall. The resected small bowel of four patients with nonchylous content showed no LM extension throughout the intestinal wall. ConclusionsLMs with chylous content seem to develop from malformed lymphatic channels within the bowel wall. In such cases, segmental intestinal resection is mandatory. In contrast, mesenteric LMs with nonchylous content can potentially be treated without bowel resection if the blood supply can be preserved. This finding is, to the best of our knowledge, reported in the present study for the first time.

Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution

BackgroundTo explore the clinical characteristics, diagnosis and treatment of obturator hernia.MethodsEighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed.ResultsThirty days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients (24/59, 40.7%). There were 4 deaths (4/59, 6.8%) in this group, all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3-year recurrence rates of 5.1% (3/59) and 7.1% (1/14) were observed in the emergency surgery and the elective surgery group, respectively.ConclusionsCT examination plays an important role in improving the diagnostic rate of obturator hernia. Timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, intestinal resection and postoperative complications may be the important factors leading to postoperative death.

Jejunal variceal rupture in a patient with myelofibrosis: a case report

An 80-year old man with myelofibrosis and chronic renal disease was admitted to our hospital because of severe anemia and gastrointestinal bleeding. Although no bleeding was observed by upper or lower endoscopy, contrast-enhanced computed tomography revealed an enhanced area in the small intestinal wall that was suspected of being the bleeding site, and was confirmed by double-balloon endoscopy. Based on endoscopic findings, it was difficult to differentiate between variceal rupture and collapse of a submucosal tumor. We performed segmental resection of the small intestine to make a definitive diagnosis and achieve reliable hemostasis. The gross findings confirmed a variceal rupture from the small intestine. His gastrointestinal bleeding stopped and his anemia improved following surgery. Although some cases of portal hypertension in association with myelofibrosis have been reported, we are aware of no prior reports of variceal rupture in the small intestine. To our knowledge, this is the first reported case of ectopic jejunal varices in a patient with myelofibrosis.

Clinical Spectrum and Outcomes of Neonatal Necrotizing Enterocolitis

The objective of the study was analysis of risk factors associated with outcome of necrotizing enterocolitis (NEC) in infants in a single-center study. All consecutive infants hospitalized for NEC over a period of 6 years were retrospectively analyzed for clinical course, infections, treatment and outcome. Out of 76 patients, surgical management was applied in 56 (53 exploratory laparotomy, three initial peritoneal drain placement) and in 20 there was only a conservative approach. Segmental intestinal resection was performed in 41 patients. Survival from NEC in our cohort was 79%. We found that independent adverse risk factors of outcome of newborns and infants with NEC were gut perforation, infection, abdominal wall erythema, and development of acute kidney injury. We underline the value of both surgical and conservative approach with careful management in this cohort of patients.

P-222 Primary malignant tumors of the small intestine: Clinical and therapeutic aspects

Malignant tumors of the small intestine are uncommon, accounting for less than 2% of digestive tract cancer. However, it is the first etiology for endocrine tumors, lymphomas or stromal tumors. They are characterized by anatomopathological heterogeneity and non-specific symptomatology. This causes a diagnostic delay and a fairly severe prognosis. This is a retrospective study that included patients with small intestine cancer who were treated in the Medical Oncology department from January 2015 to June 2019. The objective was to study the epidemiological, diagnostic and therapeutic and prognostic factors of small intestine cancer and to relate our experience in their therapeutic management. Forty-three cases were reported, with median age 58.2 years (37 to 86 years), with a male predominance (the sex ratio M/F of 1.3). 20,9 % of patients were diagnosed with complications such as acute occlusive syndrome or intestinal perforation. The tumor localization was 23.2% in the jejunum, 32.5% duodenal and 44.1% ileal. Histologically, adenocarcinoma was the most common type (51.2%) followed by neuroendocrine carcinoma (27.9% of cases) and stromal tumors (16.2% of cases). The majority of cases were diagnosed with advanced metastatic disease (55.8% of cases). The sites of metastasis were respectively the liver (30.4%), the lung (16.6%) bone and the peritoneum (8.3%). The treatment was surgical in 44.1% of cases and consisted of a segmental intestinal resection, followed by a terminally terminal anastomosis. Seventy-nine percent of patients were eligible for systemic treatment, of which 23.6% were in the adjuvant setting and 55.8% in palliative cases. The chemotherapy protocol depended on the histological type and was dominated by the 5FU-oxaliplatin combination in carcinomas, while the stromal tumors received TKI. After a median follow-up of 52.7 months, the median progression-free survival was 11.2 months and the median overall survival was 16.8 months all histological types combined. Malignant tumors of the small intestine pose diagnostic problems because of their scarcity and the absence of specific clinical signs. They are often operative discoveries in the event of an acute complication. The curative treatment is surgical resection regardless of the histological type. The prognosis remains reserved because of the late diagnosis of the tumor.

Mesenteric vascular and nerve sparing surgery in laparoscopic segmental intestinal resection for deep infiltrating endometriosis

Objective(s)To investigate Mesenteric vascular and nerve Sparing Surgery (MSS) as surgical laparoscopic technique to perform segmental intestinal resection for deep infiltrating endometriosis (DIE). Study DesignProspective cohort study between January 2013 and December 2016. Consecutive patients with suspected intestinal DIE underwent clinical and imaging evaluation to confirm intestinal involvement. Indications for radical surgery and surgical technique (intestinal resection versus shaving) were consistent with Abrão algorithm. Surgeons aimed to perform MSS in all the consecutive patients that required intestinal resection. MSS consists in mesenteric artery, branching arteries, and surrounding nerve fibers preservation by dissecting mesentery adherent to the intestinal wall. Data about history, preoperative and post-operative evaluation, surgery and complications were recorded. Symptoms were evaluated before and 30–60 days after surgery with numeric rating scale for pain. Constipation was evaluated with the Constipation Assessment Scale (CAS). Patients with diagnosis of irritable bowel syndrome, inflammatory bowel diseases, diverticulitis, and previous segmental intestinal resection were excluded. ResultsSixty-two out of 75 (82.7%) consecutive women with intestinal endometriosis underwent laparoscopic segmental intestinal resection performed with MSS. Major complications that required repeated operation occurred in 4 cases (6.5%). Anastomotic leakage occurred in only 1 case (1.6%). Dysmenorrhea (p < .001; r = -0.86), dyspareunia (p < .001; r = -0.80), dyschezia (p < .001; r = -0.86) and dysuria (p < .001; r = -0.56) were significantly improved after surgery. After an average of 33.1 months from surgery, severe constipation was reported only by two patients (3.6%) (CAS: 13–16). The median time from surgery to intestinal function recovery (flatus or stool passage) was one day. Logistic regression analysis showed constipation related to the distance from anal verge and time since surgery. Conclusion(s)MSS in laparoscopic intestinal resection for DIE may be reproducible, safe and effective. MSS could be combined with pelvic nerve-sparing surgery as an effective approach to improve intestinal symptoms after radical surgery for DIE that requires segmental intestinal resection.

Enteric Duplication Cysts in Children: A Single‐Institution Series with Forty Patients in Twenty‐Six Years

The purpose of the study was to evaluate our experience with enteric duplication cysts in 40 children during the past 26years, while assessing the variability of their presentations and to propose an algorithm for surgical management. We retrospectively analysed sex, age, clinical presentations, duplication site, surgical treatment, presence of ectopic tissue, complications, associated anomalies, and prognosis of 40 patients with gastrointestinal tract duplications who were surgically treated in our clinic. Overall, there was a predominance of boys (28 males, 70%; 12 females, 30%). The presenting symptom was vomiting in 23 patients, rectal bleeding in 11 patients, abdominal mass in 10 patients, abdominal pain in 9 patients, constipation in 6 patients, cough in 2 patients, and respiratory distress in 2 patients. In 30 patients, a complete excision of the cyst with additional segmental intestinal resection and anastomosis was performed. Cystectomy was performed in seven patients, while complete excision of the cyst with additional wedge resection was performed in two. A Wrenn procedure (mucosectomy) was performed in one patient. Due to the variability in the site of enteric duplications, a wide range of presenting symptoms can exist, which is challenging for diagnosis. In children with a diagnosis of acute abdomen, enteric duplication cysts should be considered, and these children should be further investigated for additional skeletal, urogenital, and gastrointestinal system pathologies. Surgical treatment depends on the site and type of the cyst.