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[Intestinal duplications. A survey of 18 cases]
M Soares-Oliveira1, M Castañón, J L Carvalho
1ServiCo Pediatria Cirurgica. Hospital So Joo. Faculdade do Porto. Oporto. Portugal. m_soares_oliveira@hotmail.com
Insights
Intestinal duplications in children most commonly occur in the ileum and present with rectal bleeding or intussusception. Minimally invasive surgery is key for managing these congenital anomalies.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Context:
- Intestinal duplications are rare congenital anomalies affecting the gastrointestinal tract.
- Management strategies and outcomes in pediatric cases require further elucidation.
- This study reviews the experience of two centers in managing pediatric intestinal duplications.
Purpose:
- To analyze the clinical presentation, diagnosis, treatment, and outcomes of intestinal duplications in children.
- To investigate the relationship between patient age and clinical presentation.
- To evaluate the role of minimally invasive surgery in managing these anomalies.
Summary:
- A retrospective review of 18 children with intestinal duplications (median age 11 months) revealed ileal location (78%) and cystic type as most common.
- Rectal bleeding and intussusception were the predominant presentations (36% each), with intussusception more frequent in infants.
- Diagnosis involved imaging, laparoscopy, or laparotomy; treatment included segmental enterectomy or lesion excision. Minimally invasive approaches like thoracoscopy were utilized.
- No complications were observed during a mean 3-year follow-up.
Impact:
- Highlights the typical characteristics and presentation patterns of pediatric intestinal duplications.
- Emphasizes the correlation between age and clinical manifestation, aiding in timely diagnosis.
- Underscores the efficacy and importance of minimally invasive surgical techniques in managing these congenital conditions.
Objective:
The present study analyses the experience of two centers in the management of intestinal duplications in children.
Material And Methods:
We retrospectively reviewed the medical records of a series of 18 children with intestinal duplication (January 1993 to December 1999). The median age was 11 months (range: 9 days to 12 years). The variables analysed were: clinical presentation, diagnosis, localization, anatomic type, treatment, and complications. The relationship between age and clinical presentation was also analysed.
Results:
Most cases were located in the ileum (n 14; 78 %) and presented with rectal bleeding (36 %) or intussusception (36 %). Most symptomatic cases in the first year of life presented with intussusception (n 5/6). All duplications, except one located in the ascending colon, were cystic. 99mTc-pertechnate abdominal scan was positive in three out of five patients. One case was diagnosed by prenatal ultrasonography. Diagnosis was confirmed by laparoscopy in three patients and by laparotomy in the remaining patients. In one patient, cystic esophageal duplication presented in the neonatal period as respiratory distress. Diagnosis as well as excision was performed by thoracoscopy. Of the two gastric duplications, one was diagnosed by prenatal ultrasonography and the other by laparotomy. Treatment consisted of segmental enterectomy (n 14) or excision of the lesion without enterectomy (n 4). No complications were found during a mean follow-up of 3 years.
Conclusions:
The onset of intestinal duplication may be late. The lesions were most commonly located in the ileum and were cystic. Clinical presentation was related to age. Minimally invasive surgery plays an important role in the management of these lesions.