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Congenital Intestinal Duplication

Rectal Duplication


Presentation

  • Rarely, it is seen in adults who remain asymptomatic or present with vague abdominal symptoms.[ncbi.nlm.nih.gov]
  • Expert surgeons, all active both as educators and with busy clinical practices, have written concise and practical chapters on the most commonly done procedures while providing much-needed insight on less frequently presentations, as well.[books.google.de]
  • We present an unusual case of a 13 year old boy, who presented with an acute abdomen and malaena with contrasting radiological and operative findings.[adc.bmj.com]
  • 75% present in first 2 years of life 80% present with bowel obstruction Other presenting signs include melena, abdominal mass and perforation Diagnosis is most often made at laparotomy Treatment Treatment is operative resection if feasible – Cystic and[surgery4children.com]
Pain
  • Furthermore, gastrointestinal bleeding and refractory abdominal pain may be underlain with heterotopic gastric mucosae lining the duplication cyst. Therefore, antacids can be effective in relieving abdominal pain as shown in this patient.[wjgnet.com]
  • Duplications can be asymptomatic or cause obstructive symptoms, chronic pain, GI bleeding, or abdominal mass. If they are detected, treatment of intestinal duplications is surgical with complete resection of the duplicated portion.[msdmanuals.com]
  • The patient had an uneventful post-operative recovery and is living a pain-free, normal life.[ncbi.nlm.nih.gov]
Asymptomatic
  • Rarely, it is seen in adults who remain asymptomatic or present with vague abdominal symptoms.[ncbi.nlm.nih.gov]
  • Duplications can be asymptomatic or cause obstructive symptoms, chronic pain, GI bleeding, or abdominal mass. If they are detected, treatment of intestinal duplications is surgical with complete resection of the duplicated portion.[msdmanuals.com]
  • The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.[wjgnet.com]
Weight Loss
  • CASE REPORT A 25-year-old Han Chinese man complained of chronic abdominal pain and weight loss for 3 years.[wjgnet.com]
  • loss of 10 kg.[acgcasereports.gi.org]
  • Patients may also develop jaundice, persistent vomiting, weight loss and fluid within the abdomen. Diagnosis (“What tests are done to find out what my child has?”)[eapsa.org]
  • loss, dysphagia, dyspepsia and anaemia.[journalofmas.com]
  • There was no history of jaundice, gastrointestinal bleeding, melena, weight loss or altered bowel habits. There was no history of diabetes mellitus, tuberculosis, hypertension or cardiac disease.[pancreas.imedpub.com]
Surgical Procedure
  • Malignant development of this mucosal lining as well as cases of carcinoid tumors have been reported. 3 Many lesions, however, are asymptomatic and the diagnosis is often made incidentally during a surgical procedure. 2 Reported cases of ED in an omphalocele[nature.com]
  • Good sectioning of the cyst wall with the attached bowel helps in ruling out the malignant changes. [3] Various surgical procedures have been employed to deal with such lesions.[ijhas.in]
  • On the fourth day following admission the patient suffered a haemorrhagic shock and underwent an emergency surgical procedure with a bleeding diverticulum on the posterior wall of the duodenum tightly adhering to the pancreas being found.[giornalechirurgia.it]
  • procedures, imaging studies, autopsy records, or transfer hospitalization records.[nejm.org]
Inflammation
  • The resection specimen showed no signs of inflammation, infection, ulceration, hemorrhage, obstruction or malignant transformation (Figure 4A ).[wjgnet.com]
  • Some of these include Colorectal cancer Colonic polyps - extra tissue growing in the colon that can become cancerous Ulcerative colitis - ulcers of the colon and rectum Diverticulitis - inflammation or infection of pouches in the colon Irritable bowel[icdlist.com]
  • This type of fluid collection is a result of inflammation of the pancreas ( pancreatitis ) or trauma to the pancreas. The fluid leaks from the injured pancreatic ducts and collects in areas next to the pancreas.[eapsa.org]
  • Histopathological examination demonstrated a benign cystic lesion covered by respiratory epithelium transitioning focally into gastric mucosa with inflammation and microfoci of haemorrhages and intact smooth muscle layer, suggesting duplication cysts[journalofmas.com]
  • The absence of inflammation of the pancreas or a solidcystic component and the presence of finger-like projections and sonographic features of a layered pattern should help in a correct diagnosis.[pancreas.imedpub.com]
Abdominal Mass
  • Duplications can be asymptomatic or cause obstructive symptoms, chronic pain, GI bleeding, or abdominal mass. If they are detected, treatment of intestinal duplications is surgical with complete resection of the duplicated portion.[msdmanuals.com]
  • An intestinal DAT may be asymptomatic, while chief complaints consist mainly of belly pain, abdominal mass, intestinal obstruction, and hematochezia[ 5 ].[wjgnet.com]
  • Adult small intestinal duplication cyst presenting as a post appendicectomy abdominal mass. Sri Lanka Journal of Surgery, 33(3), pp.20–21. DOI: Published on 16 Nov 2015. Peer Reviewed Downloads PDF (EN)[sljs.sljol.info]
Melena
  • We concluded that the abdominal pain, anemia, and melena were caused by the ileal duplication. We will perform surgical excision, including partial resection of the ileum.[springerplus.springeropen.com]
  • However, intermittent abdominal pain free of hematochezia or melena, suggestive of intestinal obstruction, still recurred following appendectomy.[wjgnet.com]
  • Figure 4: Long tubular duplication of small intestine presenting as melena in a 2 months old infant.[sjmms.net]
  • Most commonly found at the ileocecal junction -cysts shares a common blood supply and wall with ileum -Gastric mucosa found within 20% Presentation 75% present in first 2 years of life 80% present with bowel obstruction Other presenting signs include melena[surgery4children.com]
  • Denis McCarthy Digestive Diseases and Sciences. 2019; 64(2): 349 3 Symptomatic Duodenal Duplication Cyst Treated Endoscopically Mafalda Sousa,Luísa Proença,Sónia Fernandes GE - Portuguese Journal of Gastroenterology. 2019; 26(2): 145 4 Visual Diagnosis: Melena[eusjournal.com]
Hematochezia
  • However, intermittent abdominal pain free of hematochezia or melena, suggestive of intestinal obstruction, still recurred following appendectomy.[wjgnet.com]
  • Rectal duplications: Presenting features of colonic or presacral duplications may include constipation, rectal bleeding, hematochezia, rectal prolapse, hemorrhoids, fistula-in-ano and perirectal abscess besides presenting as a mass behind the anus.[sjmms.net]
  • […] gastrointestinal 胃腸の gastrojejunostomy胃空腸吻合術 gastroptosis胃下垂 glucose tolerance耐糖性 graft-versus-host disease (GVHD)移植片対宿主病 gram-negative bacilli グラム陰性桿菌 greater curvature大彎 h hamartoma過誤腫 heartburn胸やけ Helicobacter pylori ヘリコバクターピロリ hemangioma血管腫 hematemesis吐血 hematochezia[tokyo-med.ac.jp]
Intestinal Disease
  • Centers for Disease Control and Prevention Intersex (Medical Encyclopedia) [ Read More ] Colonic Diseases Also called: Large intestine diseases Your colon, also known as the large intestine, is part of your digestive system.[icdlist.com]
  • Most adult enteric duplications are diagnosed incidentally in perioperative or autopsy cases because noninvasive conventional radiologic and endoscopic techniques provide limited information about small intestinal disease.[springerplus.springeropen.com]
Intestinal Disease
  • Centers for Disease Control and Prevention Intersex (Medical Encyclopedia) [ Read More ] Colonic Diseases Also called: Large intestine diseases Your colon, also known as the large intestine, is part of your digestive system.[icdlist.com]
  • Most adult enteric duplications are diagnosed incidentally in perioperative or autopsy cases because noninvasive conventional radiologic and endoscopic techniques provide limited information about small intestinal disease.[springerplus.springeropen.com]
Strabismus
  • The study aims to investigate the ability of maxillofacial surgery to reduce strabismus and improve ocular clinical symptomatology in patients with fracture of the medial or lateral floor of the orbit, or both, and to evaluate such abilities relative[giornalechirurgia.it]

Workup

  • Moreover, Tc-99m pertechnetate scintigraphy is recommended as the first-line option of choice for the workup of DAT[ 16 ]. The positive result depends mainly on the abnormal enrichment of radionuclides accumulated by the heterotopic gastric mucosae.[wjgnet.com]
  • Computed tomography (CT) scan: CT scan, especially multi detector CT of the chest or abdomen is useful in establishing a diagnosis of alimentary tract duplication during the preoperative workup and may be used to evaluate synchronous distant lesions once[sjmms.net]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.de]
  • If they are detected, treatment of intestinal duplications is surgical with complete resection of the duplicated portion. For proximal lesions, an endoscopic approach can be considered when a highly skilled endoscopist is available ( 1 , 2 , 3 ).[msdmanuals.com]
  • A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis.[wjgnet.com]
  • If they are detected, treatment of intestinal duplications is surgical with complete resection of the duplicated portion. For proximal lesions, an endoscopic approach can be considered when a highly skilled endoscopist is available ( 1, 2, 3 ). 1.[merckmanuals.com]

Prognosis

  • Prognosis is determined by the length and function of the remaining bowel. Long-term complications include malabsorption, feeding intolerance and bacterial overgrowth (3).[hawaii.edu]
  • Surgery is the treatment of choice and this condition has an excellent prognosis.[ijhas.in]
  • Prognosis : the prognosis is favorable in most cases, when patients experience an isolated cutaneous abnormality.[intechopen.com]
  • […] intestine is the most frequent site of GI duplications, accounting for 44% of cases [3] Colonic duplications - These may be cystic or tubular; they represent 15% percent of duplications Rectal duplications - These represent up to 5% of GI duplications [9] Prognosis[emedicine.medscape.com]

Etiology

  • The etiology of intestinal duplications is unknown. Theories include abnormalities in recanalization, a vascular insult, persistence of embryonic diverticula, and partial twinning.[msdmanuals.com]
  • Etiology The true etiology of GI tract duplications is not known. [7] Several theories have been postulated. The idea that the initial developmental abnormality occurs in the gastrulation stage and results in a split notochord has been proposed.[emedicine.medscape.com]

Epidemiology

  • Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol 2004 ;160: 301 - 305 30. Zeger SL, Liang KY, Albert PS.[nejm.org]
  • Epidemiology Exact incidence is unknown. Approximately two-thirds of all intestinal duplications are discovered within the first two years of life.[surgery4children.com]
  • Epidemiology GI duplications are observed in 1 of every 4500 autopsies, predominantly in white males. Synchronous GI duplications occur in as many as 15% of patients.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The following are examples: Thoracoabdominal duplications - Vertebral anomalies (approximately 75%) Enteric cystic duplications - Intestinal atresias Tubular hindgut duplications - Genitourinary malformations Pathophysiology GI duplications are most frequently[emedicine.medscape.com]
  • Sleisenger & Fordtran's Gastrointestinal and Liver Disease Pathophysiology / Diagnosis / Management, sixth edition. 1998, Philadelphia: W. B. Saunders Company, pp. 1423-1431. 4. Wyllie R. Chapter 330 - Intestinal Atresia, Stenosis, and Malrotation.[hawaii.edu]
  • The pathophysiological mechanisms are still unclear, with most cases occurring sporadically, although rare cases were reported in some families.[intechopen.com]
  • This approach has helped in defining the natural history of congenital anomalies, determining the pathophysiologic features that affect clinical outcome and formulating management based on prognosis.[ijri.org]

Prevention

  • Physiology 279 (2 … , 2000 94 2000 Anomalous congenital bands causing intestinal obstruction in children FM Akgür, FC Tanyel, N Büyükpamukçu, A Hiçsönmez Journal of pediatric surgery 27 (4), 471-473 , 1992 89 1992 Amnio-allantoic fluid exchange for the prevention[scholar.google.com.au]
  • It is a strong anti-reflux mechanism to prevent reflux from the cecum into the terminal ileum acting as an important barrier water shade and keeping small bowel contents free from gross contamination and bacterial overgrowth [2].[austinpublishinggroup.com]
  • Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis C Oliveira, A Nasr, M Brindle, PW Wales Pediatrics 129 (2), 318-329 , 2012 138 2012 Lung torsion after tracheoesophageal fistula repair: a case report[scholar.google.ca]
  • Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. ‎ Página 84 - Tanner JM, Whitehouse RH, Marubini E, Resele LF. The adolescent growth spurt of boys and girls of the Harpenden growth study. ‎[books.google.es]
  • If cysts grow large enough, surgery may be needed to prevent twisting of the ovary that could impact your daughter’s future ability to have children.[ohiofetalmedicine.org]

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