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Gastrointestinal Duplications: A Decade's Experience
Rahul Gupta1, Ajay Kumar1, Liladhar Agrawal2
1Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
Insights
Gastrointestinal duplications are rare congenital anomalies often seen in infants. This study reviewed 32 pediatric cases, finding ileum as the most common site and highlighting the need for early diagnosis and individualized management for favorable outcomes.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Gastrointestinal Disorders
Background:
- Gastrointestinal (GI) duplications are uncommon congenital anomalies with varied clinical presentations.
- These malformations typically manifest in early childhood, particularly within the first two years of life.
Purpose of the Study:
- To report the experience with gastrointestinal duplications (cysts) at a tertiary pediatric surgery center.
- To analyze the clinical characteristics, management, and outcomes of pediatric GI duplications.
Main Methods:
- A retrospective observational study was conducted.
- Data from 32 pediatric patients diagnosed with GI duplications between 2012 and 2022 were analyzed.
- Patient demographics, clinical presentation, radiological findings, surgical management, and outcomes were reviewed.
Main Results:
- Thirty-two cases of GI duplication were identified, with a slight male predominance (M:F ≈ 4:3).
- The majority of patients (81.25%) were under two years old, with 46.88% presenting neonatally.
- The ileum was the most frequent location (17 cases), followed by the gallbladder (6 cases). Common associated pathologies included intussusception (6 cases) and intestinal atresia (5 cases).
- Favorable outcomes were observed in 75% of the cases.
Conclusions:
- GI duplications present diversely based on location, size, and associated complications.
- Clinical suspicion and accurate radiological evaluation are crucial for early diagnosis to prevent complications.
- Management strategies should be tailored to the specific type of duplication and its relationship with the gastrointestinal tract.
Context:
Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life.
Aims:
To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute.
Settings And Design:
It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications.
Materials And Methods:
All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes.
Results:
Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases (n = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum (n = 17), followed by gallbladder (n = 6), appendix (n = 3), gastric (n = 1), jejunum (n = 1), esophagus (n = 1), ileocecal junction (n = 1), duodenum (n = 1), sigmoid (n = 1), and anal canal (n = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception (n = 6) was the most common, followed by intestinal atresia (n = 5), anorectal malformation (n = 3), abdominal wall defect (n = 3), hemorrhagic cyst (n = 1), Meckel's diverticulum (n = 1), and sacrococcygeal teratoma (n = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases.
Conclusion:
GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract.
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