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Alimentary tract duplications in infants and children
A B Pintér1, W Schubert, F Szemlédy
1Children's Department, Medical University of Pécs, Hungary.
Insights
Alimentary tract duplications are rare congenital anomalies. Surgical removal is effective, emphasizing careful preservation of shared blood supply to prevent complications.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Disorders
Background:
- Alimentary tract duplications are rare congenital malformations.
- This review analyzes 30 cases from 1964-1989 in Hungary and Germany.
Observation:
- The study included 28 patients, with 80% presenting before age two.
- Abdominal pain, vomiting, and obstruction were common symptoms.
- Thoracic, abdominal, and thoraco-abdominal duplications were observed, with cystic types predominating.
Findings:
- Diagnostic imaging included X-rays, ultrasonography, and barium studies.
- Emergency surgery was required in 18 patients.
- Successful surgical excision was achieved, with one unrelated mortality.
Implications:
- Surgical intervention should be conservative, focusing on complete excision.
- Preserving the shared blood supply during surgery is crucial to avoid sacrificing healthy bowel tissue.
- Understanding these rare conditions aids in optimizing pediatric surgical outcomes.
Abstract:
This is a review of 30 duplications of the alimentary tract in 28 patients treated at the Surgical Unit of the Children's Department of the Medical University of Pécs, Hungary, and at the Department of Pediatric Surgery of the Medical Academy of Dresden, Germany, from 1964 to 1989. The ages of patients ranged from 1 day to 13 years, 80 percent were less than 2 years of age at initial presentation. There were 6 thoracic, 20 abdominal and 2 thoraco-abdominal duplications. Distended abdomen, vomiting, bowel obstruction and palpable abdominal mass were most frequently encountered. Plain thoracic and abdominal x-rays, ultrasonography, barium esophagogram, barium meal and enema were the most common diagnostic procedures. Emergency operative intervention was required in 18 patients. One infant died of an unrelated disease. Twenty-three duplications were cystic and 3 tubular. One patient had an appendiceal duplication, and another patient a flat lumenless duplication located on the perineum close to the anal opening. The surgical procedure--removal of the duplication--should not be more radical than necessary to eliminate the potential complaints and prevent recurrence. During surgery the common blood supply shared between the duplication and the native bowel must be carefully protected to avoid undue sacrifice of normal bowel.