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Duplications of the alimentary tract in children
N A Bhat1, S Agarwala, D K Mitra
1Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
Insights
Alimentary tract duplications are rare congenital anomalies, often diagnosed in early childhood. Early diagnosis and surgical intervention are crucial for favorable outcomes in affected patients.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Alimentary tract duplications are rare congenital malformations.
- These anomalies can present with diverse clinical manifestations.
- Management requires a thorough understanding of their anatomy and presentation.
Purpose of the Study:
- To evaluate the clinical, diagnostic, and therapeutic strategies for alimentary tract duplications.
- To review existing literature on this condition.
- To analyze a cohort of patients treated for alimentary tract duplications.
Main Methods:
- Retrospective analysis of 28 patients treated between 1990 and 1999.
- Review of clinical data, diagnostic imaging, and surgical outcomes.
- Literature review for comparison with existing data.
Main Results:
- Male predominance (25:3) and a high incidence in children under 2 years (71%).
- Common locations include jejunum and ileum; thoracoabdominal duplications were more frequent (20%) than previously reported.
- Diagnostic tools included ultrasonography, CT scans, and in select cases, 99m-Tc-pertechnetate scans and barium studies.
Conclusions:
- Alimentary tract duplications necessitate a tailored surgical approach based on lesion characteristics.
- Familiarity with the varied presentations and anatomical details is essential for optimal surgical management.
- Prompt diagnosis and intervention improve patient outcomes.
Abstract:
This study was conducted to assess the clinical, diagnostic and therapeutic approach in patients with alimentary tract duplication and review the relevant literature. A retrospective analysis of 28 patients of alimentary tract duplications treated between January 1990-December 1999 was carried out. There was a male preponderance (25:3); 71% of the patients were under 2 years of age. The presenting features were related to the anatomic location. Three patients were diagnosed antenatally. Real time ultrasonography and CT scan was undertaken for preoperative evaluation in the majority of patients. In selected cases a 99m-Tc-pertechnetate scan and barium meal follow through examination were also performed. Majority of duplications were in the jejunum and ileum. Twenty percent of our patients had thoracoabdominal duplication as compared to 2% reported in literature. Four patients required to be operated upon in the emergency for related complications. In the remaining patients complete excision of the cyst was done in 21 and only mucosectomy in 3 patients. Because these lesions are rare and can present with a wide range of clinical manifestations or may even be encountered intraoperatively, the appropriate surgical management requires the surgeon to be familiar with the anatomy and clinical characteristics of these lesions.