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Management of alimentary tract duplication in children
M D Stringer1, L Spitz, R Abel
1Department of Paediatric Surgery, Hospital for Sick Children, London, UK.
Insights
Alimentary tract duplications are rare, dangerous congenital anomalies in children. Surgical complications, morbidity, and mortality are significant, particularly with thoracoabdominal types, necessitating complete excision.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Alimentary tract duplications are uncommon congenital malformations.
- These anomalies can present significant diagnostic and therapeutic challenges.
- Previous literature highlights the potential for severe complications.
Purpose of the Study:
- To review the clinical presentation, management, and outcomes of children with alimentary tract duplications.
- To identify factors associated with increased morbidity and mortality.
- To evaluate the effectiveness of surgical management.
Main Methods:
- Retrospective review of 72 children treated for alimentary tract duplication.
- Data collected on patient demographics, duplication type, location, and surgical management.
- Analysis of postoperative complications, mortality, and long-term outcomes.
Main Results:
- Ileal duplications were most frequent (22%).
- Thoracoabdominal duplications were associated with the highest morbidity and mortality.
- Complications linked to duplication size, location, communication with other structures, heterotopic gastric mucosa, and mesenteric vessel involvement.
Conclusions:
- Alimentary tract duplications pose substantial risks, with significant postoperative complications and mortality.
- Surgical success depends on careful consideration of anatomical factors.
- Complete surgical excision is the recommended treatment approach.
Abstract:
Duplication of the alimentary tract is rare but potentially dangerous. Five of 72 children with alimentary tract duplication treated between 1973 and 1992 died from postoperative complications; a further ten required more than one operation. Ileal duplications were the commonest, occurring in 16 patients (22 per cent). Thoracoabdominal duplications were the most complicated and responsible for much of the overall morbidity and mortality. Surgical complications were related to the size and location of the duplication, communication with the gastrointestinal tract or vertebral canal, presence of heterotopic gastric mucosa and involvement of mesenteric vessels. Complete excision of the duplication should be possible in most cases.