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[Esophageal duplication in children. Report of 7 cases]
M Mekki1, M Belghith, I Krichene
1Service de chirurgie pédiatrique, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
Insights
Esophageal duplications are rare congenital anomalies. Early diagnosis, often before six months, and surgical excision are crucial for favorable outcomes in children.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Congenital Malformations
Context:
- Esophageal duplications are uncommon congenital anomalies, comprising 10-20% of esophageal malformations.
- These duplications are part of the broader spectrum of digestive duplications, accounting for 15-20%.
Purpose:
- To report a series of seven pediatric cases of esophageal duplications.
- To analyze the diagnostic methods, clinical presentations, and surgical outcomes.
Summary:
- Seven cases of esophageal duplications were analyzed, with diagnosis typically occurring before six months of age.
- Clinical signs included respiratory and digestive issues. Diagnosis was often associated with mediastinal masses and vertebral malformations.
- Surgical excision led to favorable outcomes in six of seven patients, with a four-year average follow-up.
Impact:
- Highlights the importance of early diagnosis and surgical intervention for esophageal duplications.
- Emphasizes the association between posterior mediastinal masses, vertebral malformations, and esophageal duplications.
- Underscores the need for prompt surgical treatment to prevent complications.
Unlabelled:
Esophageal duplications represent 10 to 20% of esophageal malformations and 15 to 20% of digestive duplications.
Methods:
The authors report a series of seven cases observed between 1985 and 1999.
Results:
The sex ratio was 2.5. The diagnosis was made before the age of six months in five cases. The clinical presentation included respiratory signs in six cases and digestive signs in five cases. The diagnosis was made on the association of a mediastinal mass behind vertebral malformation in five cases. The duplication was cystic in five cases and tubular in two. A perforation in the pleura occurred in one case of tubular duplication. The intervention consisted of total excision of the duplication in four cases and subtotal resection in two cases. For the seventh patient, who presented a perforation of the duplication in the pleura, the operation comprised a thoracic drainage associated to feeding gastrostomy. The histologic examination of the six operative specimens confirmed the diagnosis of esophageal duplication. Six patients survived and have favorable evolution with an average follow-up of four years.
Discussion:
Esophageal duplications represent 15 to 20% of digestive duplications. Their clinical presentations are variable. Their diagnosis is often made before the age of two years, when a posterior mediastinal mass is associated with vertebral malformations. Apart from the tubular form, which is rare, diagnosis is confirmed by the histologic study of the operative specimen.
Conclusion:
Esophageal duplications are rare and often pose a problem of positive diagnosis. Their treatment is surgical and should be undertaken before the appearance of complications.