Gastrointestinal Duplications: A Decade's Experience

Abstract

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.

Keywords: Anorectal malformation; associated anomalies; atresia; duplications; gastrointestinal; pediatric.

Figure 1

Contrast enema showing sigmoid obstruction with dye extravasating into the duplication cyst (yellow arrow, a); intraoperative photograph of this patient with sigmoid duplication (black arrow, b). Intraoperative photographs showing gastric duplication (held with Babcock's forceps) with associated duodenal atresia (c)

Figure 2

Intraoperative photographs showing gallbladder (GB) duplication associated with gastroschisis (a), ileal atresia (b), and multiple intestinal atresias (c). Line diagram (d) showing the anatomy of GB duplication; with duplication of the body (red arrows) with a single cystic duct (star) forming a V-shaped type duplication (junction of the GBs [blue arrow], common hepatic duct [green arrow], common bile duct [yellow arrow] and round ligament [black arrow]). GB: Gallbladder

Figure 3

Radiograph of a patient with anorectal malformation showing a large dilated bowel loop shadow (white arrow) on the left side of the abdomen (a); intraoperative photograph (b) showing congenital pouch colon (CPC) type 2 (white arrow) with appendicular duplication (green arrows). Intraoperative photographs (c and d) show CPC type 2 along with appendicular duplication under the intestinal clamps (c) and forceps (d). CPC: Congenital pouch colon

Figure 4

CT images: coronal film (a) showing 97 mm × 78 mm × 68mm hypodense (cystic) lesion in right hemithorax and cystic swelling in the abdomen; transverse abdominal images (b and c) showing hypodense (cystic) lesion. Preoperative photograph (d) of a patient with long tubular small intestinal duplication (e) and excised specimen (inset image, f). Thoracotomy showing esophageal duplication (g) and resected specimen (h). CT: Computed tomography

Figure 5

Preoperative photographs showing marked lump (a); CT films showing fluid-filled hypodense tubular mass (b-e); intraoperative photograph showing long tubular duplication cyst arising from the terminal ileum (f) and resected specimen (g); intraoperative photograph showing long tubular duplication with luminal communication of the GI tract with the duplication (h) and resected specimen (i). CT: Computed tomography, GI: Gastrointestinal