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Enteric duplication in children: Experience from a tertiary center in South India
Susan Jehangir1, Pradeep Joseph Ninan1, Tarun John Jacob1
1Department of Pediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
Enteric duplications (EDs) are rare congenital anomalies. This study highlights their varied presentation and challenges in the Indian population, noting increased thoracoabdominal EDs.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Malformations
Background:
- Enteric duplications (EDs) are rare congenital malformations of the embryonic gastrointestinal tract.
- This study focuses on the clinical characteristics and management of EDs within the Indian population.
Purpose of the Study:
- To define the clinical features of enteric duplications in Indian children.
- To outline the management strategies and challenges associated with EDs in this demographic.
Main Methods:
- Retrospective analysis of hospital records for 35 children with 38 EDs operated between 2003 and 2014.
- Inclusion of follow-up data to assess outcomes.
Main Results:
- Small bowel duplications were most frequent (44%), with a higher incidence of thoracoabdominal EDs (8%) compared to literature (2%).
- Associated anomalies, particularly vertebral and spinal, were present in 49% of cases.
- Ultrasonography (US) showed 55% sensitivity; Technetium(99m) scintigraphy had 80% positive predictive value for gastrointestinal bleeds. No postoperative mortality was observed.
Conclusions:
- Enteric duplications present with nonspecific symptoms, necessitating a high index of suspicion.
- Thoracoabdominal EDs appear more prevalent in the Indian population.
- While US is a useful screening tool, complete excision is ideal; internal drainage is a viable alternative when complete removal is not feasible. Long-term prognosis is influenced by associated anomalies.
Background:
Enteric duplications (EDs) are rare aberrations of the embryonic gut. This study was undertaken to define the clinical characteristics and management challenges of this unusual entity in the Indian population.
Materials And Methods:
Hospital records of 35 children with 38 ED operated between 2003 and 2014 were analyzed and followed up.
Results:
The median age at presentation was 285 days (range 1-day to 16 years) with male preponderance (71%). Small bowel duplications were the most common (44%), and thoracoabdominal duplications were seen in 8% children compared to 2% in the literature. The median duration of symptoms was 18 days (interquartile range [IQR] 3-210 days). Associated anomalies were seen in 49% children with vertebral and spinal anomalies being the most common. Ultrasonogram (US) was done in 83% children and had a sensitivity of 55%. In the presence of a gastrointestinal bleed, Technetium(99m) pertechnetate scintigraphy scan had a positive predictive value of 80%. Thirty-five lesions were completely removed. Mucosectomy was done in two children, and one total colonic duplication was left in situ after providing adequate internal drainage. There was no postoperative mortality. The follow-up was possible in 66% children.
Conclusions:
EDs are uncommon and have varied, nonspecific symptoms. Thoracoabdominal duplications are more common in the Indian population. The US is a good screening tool but requires a high index of suspicion where complete excision is not possible; the provision of adequate internal drainage is an acceptable alternative. The long-term prognosis of children with ED depends on the extent of physiological disturbance due to associated anomalies.
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