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Foregut duplications
1Department of Surgical Paediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow G38SJ, Scotland.
Insights
Foregut duplication cysts in children are rare but serious congenital anomalies. Early diagnosis and surgical treatment are crucial for managing these gastrointestinal and respiratory complications.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Foregut duplications are rare congenital anomalies that can present with diverse symptoms.
- Diagnosis and management can be challenging due to varied clinical presentations.
Purpose of the Study:
- To review the clinical characteristics, diagnostic methods, and surgical outcomes of children treated for foregut duplications.
- To highlight the importance of considering duplication cysts in the differential diagnosis of pediatric respiratory and gastrointestinal symptoms.
Main Methods:
- Retrospective review of 21 pediatric patients treated for foregut duplications over a 42-year period.
- Analysis of patient demographics, clinical presentation, diagnostic modalities, surgical procedures, and histological findings.
Main Results:
- The mean age at diagnosis was 1 year 6 months, with respiratory and gastrointestinal symptoms predominating.
- Surgical treatment had a 10% mortality rate. Gastric mucosa was the most common epithelial lining (15 cases).
- Associated congenital anomalies, particularly vertebral abnormalities, were present in 9 patients.
Conclusions:
- Foregut duplication cysts require a high index of suspicion in children with unexplained respiratory or gastrointestinal issues.
- Timely surgical intervention is essential for favorable outcomes, despite associated risks.
- Awareness of associated anomalies, such as vertebral defects, is important for comprehensive patient care.
Abstract:
Twenty-one children were treated for foregut duplications at the Royal Hospital for Sick Children over a 42-year period. There were 11 males and 10 females. The mean age at diagnosis was 1 year 6 months; antenatal diagnosis was made in 1 case. Respiratory and gastrointestinal (GI) presentation predominated. The diagnosis was made by chest radiograph (10), barium swallow (5), at operation (4), and by ultrasound (2). All patients were treated surgically; the mortality was 10%. The histology of the epithelial lining of the duplications revealed gastric mucosa in 15 cases; in 5 the duplication cyst was lined by more than one cell type. Nine patients had other associated congenital anomalies, the majority of these were vertebral abnormalities. The size of this series emphasises that clinicians should be aware that duplication cysts occur and should be considered in a child with unusual respiratory or GI symptoms.
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