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Enteric duplications presenting as antenatally detected abdominal cysts: is delayed resection appropriate?
P T Foley1, N Sithasanan, R McEwing
1Department of Paediatric Surgery, The Women's and Children's Hospital, North Adelaide, SA, Australia.
Insights
Delayed elective resection is a safe option for most antenatally detected enteric duplication cysts. While many remain asymptomatic, the presence of gastric mucosa necessitates eventual surgical removal.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Gastrointestinal Surgery
Background:
- Antenatal detection of intraabdominal cysts is increasing.
- Enteric duplication cysts are a subset of these antenatally detected anomalies.
Purpose of the Study:
- To evaluate the outcomes of delayed elective resection for antenatally detected enteric duplication cysts.
- To assess the risks associated with expectant management versus early intervention.
Main Methods:
- Retrospective case note review of 37 fetuses with intraabdominal cysts.
- Analysis of 12 cases identified as enteric duplications (duodenal, jejunoileal, ileocecal).
- Evaluation of outcomes following serial ultrasound monitoring and elective resection of asymptomatic cysts.
Main Results:
- Three neonates required emergency laparotomy due to small bowel obstruction.
- One ileocecal duplication became symptomatic at 2 months, necessitating laparotomy.
- Seven asymptomatic duplications were electively resected between 6 weeks and 14 months; four contained gastric mucosa.
Conclusions:
- Most intraabdominal enteric duplication cysts detected antenatally remain asymptomatic for a period, allowing for planned elective resection.
- The presence of gastric mucosa in resected cysts indicates a potential risk, advising against indefinite observation.
- Laparoscopically assisted resection of ileocecal duplications is a safe and effective surgical approach.
Purpose:
The aim of this study was to evaluate delayed elective resection of antenatally detected enteric duplication cysts.
Methods:
A retrospective casenote study of intraabdominal cysts detected antenatally between January 1991 and January 2002 found 37 fetuses with cysts. Twelve were enteric duplications. Two were duodenal, 1 was an 85-cm tubular jejunoileal duplication, and 9 were ileocecal. Asymptomatic cysts were followed with serial ultrasound scars and resected electively over 14 months.
Results:
Three neonates had small bowel obstruction demanding laparotomy: 1 of the 2 infants with duodenal duplication cysts, 1 infant with an ileocecal duplication, and the infant with the tubular duplication. One with an ileocecal duplication became symptomatic at 2 months and underwent a laparotomy. Seven had their duplications resected electively between 6 weeks and 14 months, and the other is still being followed. Four of the 7 asymptomatic duplications electively resected contained gastric mucosa.
Conclusions:
Intraabdominal enteric duplication cysts are increasingly likely to be detected antenatally. The majority are likely to remain asymptomatic for several months at least, after which a resection can be planned. The prevalence of gastric mucosa suggests that they should not be left indefinitely. Laparoscopically assisted resection of ileocecal duplications is safe and effective.
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