Diagnosis and treatment of gastric duplication in children: A case report

Abstract

Gastric duplication is a rare congenital abnormality, and its diagnosis and treatment may be challenging in certain children. The present study reported four cases of gastric duplication who were followed-up and treated in the Children's Hospital of Zhejiang University between March 2010 and March 2015. The study aimed to increase the knowledge on this disease in order to improve the diagnosis and treatment, as well as decrease the possibility of misdiagnosis. Diagnosis could not be confirmed by the clinical manifestation, ultrasonography and computed tomography (CT). Therefore, laparoscopic examination and laparotomy were conducted, which confirmed the gastric duplication, and resection was performed according to the type of gastric duplication. Two patients received laparoscopy-assisted resection by removing the duplicated gastric tube through the navel, while one patient received total laparoscopic resection, and one patient received laparoscopy and laparotomy. The surgical procedures were performed without any issues, and no complications appeared following the surgery. The preoperative symptoms disappeared completely, and the patients recovered well according to the follow-ups conducted at 1 month, 1 year and 3 years for all four cases. In conclusion, gastric duplication is a rare condition and its preoperative diagnosis is difficult, and laparotomy is an effective method for diagnosis. Laparoscopy-assisted resection or total laparoscopic resection is preferred for uncomplicated gastric duplications, and simple excision can achieve a good therapeutic effect.

Keywords: diagnosis; gastric duplication; laparoscopy; laparotomy.

Figure 1.

(A) Contrast-enhanced computed tomography demonstrated an upper abdominal cystic space-occupying lesion (arrow) in case 1. (B) Mass (indicated by the arrow) resected by laparoscopic-assisted resection by pulling out through the navel in case 1. The size of the mass was approximately 6.0×3.0×2.5 cm, and the wall was complete.

Figure 2.

Computed tomography indicated a left upper abdominal cystic lesion (arrow) in case 2.

Figure 3.

(A) Computed tomography scanning demonstrated a 1.2×1.7×1.0-cm nodular soft tissue lesion with uniform density at the distal stomach (arrow), and gastric stromal tumor was considered in case 3. (B) Hematoxylin and eosin staining of gastric body gland mucosal under ×50 magnification. The intramucosal congestion was evident, part of the epithelial tissue was eroded and the complete submucosal smooth muscle layer was visible in case 3.

Figure 4.

(A) Ultrasonography examination identified an abdominal cystic mass (arrow) in case 4, which was 3.9×3.2×3.0 cm in size with a 0.4 cm cyst wall. (B) Surgical repair of the stomach (black arrow). The repeated gastric mass adhered to and corroded the transverse colon, and a fistula was formed (white arrow). Intestinal perforation was visible when cut off. (C) The gross specimen was 4.5×3.0×3.0 cm in size, and was a single cyst gastric duplication deformity without communication with gastric cavity.