Gastrointestinal duplications: Experience in seven children and a review of the literature

Abstract

Background/aim: Enteric duplication (ED) is a rare congenital anomaly that can occur anywhere along the alimentary tract from the mouth , down to the anus and the nearby organs. This uncommon anomaly may be asymptomatic or presents with vague symptoms mimicking other common pathologies. We aim to present our experience, management challenges and patterns of ED with a review of the literature.

Settings and design: The study was carried out at a Nigerian Tertiary Hospital (2005-2008 inclusive).

Materials and methods: We retrospectively analyzed seven patients with ED managed in our hospital for sex, age, clinical presentations, duplication size and site, presence of ectopic tissue, complications, associated anomalies, radiological workups, and prognosis. Data was analyzed using SPSS 11.0 for window.

Results: Seven children between the age range of 44 hours-10 years had ED, one sublingual and six intraabdominal duplications. Midgut volvulus with long segment bowel gangrene complicated two cases. The diagnosis was incidental in all. Three cases were diagnosed following conventional radiological contrast examination and the rest at surgery. Ultrasound was not helpful in making diagnosis in all the six intraabdominal duplications. Though surgery was recommended for all, one of the patients declined. Only one patient had unsuccessful surgery.

Conclusions: ED requires high index of clinical suspicion and careful management. Many cases of nonspecific abdominal pains should be properly evaluated before patients suffer avoidable complications.

Figure 1

(a) Resected bowel of a four-month-old child (Case 5) showing duplicated terminal ileum, caecum appendix and distal colon. (b) Single contrast barium enema of same patient. Note the duplicated bowel, and dilated transverse colon