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[Intestinal duplication. A diagnostic and therapeutic challenge]
M Soares-Oliveira1, J L Carvalho, M Campos
1Serviço de Pediatria Cirúrgica, Faculdade Medicina Porto, Hospital São João, Porto.
Insights
Alimentary tract duplications are rare congenital anomalies. Early diagnosis and surgical management are crucial for reducing complications in affected children.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Disorders
Context:
- Alimentary tract duplications are uncommon congenital malformations.
- Symptoms frequently resemble other surgical conditions, leading to diagnostic challenges.
- This study reviews cases to understand diagnostic and management strategies.
Purpose:
- To analyze the clinical presentation, diagnosis, and treatment of alimentary tract duplications in children.
- To highlight the importance of experience in managing this rare anomaly.
Summary:
- Twelve pediatric cases of intestinal duplications were reviewed, with most located in the ileum.
- Common presentations included rectal bleeding, intussusception, and intestinal obstruction.
- Cystic duplications were prevalent, and 99mTc abdominal scans showed utility in specific cases.
Impact:
- Highlights the need for increased awareness and diagnostic accuracy for alimentary tract duplications.
- Emphasizes that prompt surgical intervention (enterectomy) leads to favorable outcomes.
- Underscores the significance of experienced management to minimize morbidity from this congenital anomaly.
Abstract:
Duplications of the alimentary tract are rare congenital anomalies. The symptoms often mimic other surgical diseases and the diagnostic workup presents low accuracy. The charts of twelve children with intestinal duplications were reviewed. Their ages ranged from 13 days to 12 years (median: 12 months). The majority of the cases were located at ileum (n = 9). These children presented: rectal bleeding (n = 4), intussusception (n = 3), intestinal obstruction (n = 1) and hemoperitoneum (n = 1). All that were symptomatic before 1 year of age presented with intussusception (n = 3/3). All, except one colonic case was cystic. 99mTc abdominal scan was positive in 3 cases presenting rectal bleeding. One child with gastric duplication was diagnosed prenatally. Treatment consisted of enterectomy in all but one case, with no complications. Experience in the diagnostic workup and management is important to achieve a low morbidity rate in this congenital anomaly, which may present delayed manifestations.