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| LETTER TO EDITOR |
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| Year : 2010 | Volume
: 4
| Issue : 2 | Page : 69-70 |
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Jejunal duplication cyst
Sandeep Hambarde, Pradnya Bendre
Department of Paediatric Surgery, B J Wadia Children Hospital, Parel, Mumbai - 400 012, India
| Date of Web Publication | 24-Mar-2011 |
Correspondence Address:
Sandeep Hambarde
c/o Dr. Pradnya Bendre, Department of Paediatric Surgery, B J Wadia Children Hospital, Parel, Mumbai - 400 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0331-3131.78278
How to cite this article:
Hambarde S, Bendre P. Jejunal duplication cyst. Ann Nigerian Med 2010;4:69-70 |
Sir,
Gastrointestinal duplications are rare congenital malformations that differ in size, site and symptoms. [1] Gastrointestinal duplications are observed in 1 in 4500 live births, and are common in males. The small intestine is the most frequent site involved, whereas gastric, duodenal, rectal, and thoracoabdominal involvement is relatively rare. Synchronous gastrointestinal duplications occur in as many as 15% of patients. [2] Semental resection or stripping with intestinal lengthening procedure is completely curative of the condition. [3],[4],[5],[6]
A 2-day-old neonate presented with bilious vomiting, abdominal distension and meconium not passed since birth. Child was dehydrated with palpable lump in central abdomen. C-reactive protein was 27 IU with serum sodium 129 mEq/L. After initial stabilization, ultrasound of abdomen revealed possibility of small intestinal duplication cyst. There was no associated extraabdominal or intraabdominal anomaly. On exploration, there was jejunal duplication cyst with small extension proximally till mid-duodenal level. Adjacent jejunal resection with end to end anastomosis was done. Cut open specimen showed no communication between jejunum and cyst, but they were sharing common muscular wall. Histopathology was diagnostic of duplication cyst lined by jejunal type of epithelium. Postoperative course was uneventful and child is doing well on 3 months follow-up.
First report of an intestinal duplication was published in 1733 by Calder. [7],[8] Ladd introduced the term duplication of the alimentary tract in 1939. It consists of a group of congenital anomalies with three characteristics, i.e. well-developed coat of smooth muscle, epithelial lining and attached to some portion of the gastrointestinal tract. [9],[10],[11]
One theory proposes that developmental abnormality occurs in the gastrulation stage and results in a split notochord. Some duplications of the foregut and hindgut may result from partial twinning or aberrant luminal recanalization. [12]
Clinical presentation depends on the type, size, location, and mucosal lining of the duplication. [13] Small cystic duplications present as intussusception or result in volvulus, whereas long tubular duplications with proximal communication cause acute intestinal obstruction. The diagnosis is often not established before exploration. [14]
Most small intestine duplications are located in the ileum. Duplications are either cystic or tubular and are located on the mesenteric border. Multiple small intestine duplications may be present. [3]
Ultrasonography is useful in diagnosing duplications. [5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] Computed tomography (CT) scanning may be useful in the diagnosis of duodenojejunal duplications. [18] Associated gastrointestinal bleeding due to heterotopic gastric mucosa is detected by technetium scans. [19]
Excision is the preferred treatment of alimentary tract duplications. [20] Because of the mesenteric location of most duplications, they share a common blood supply with the normal organ. [21] If feasible, segmental resection may be performed. Otherwise, one may excise or shell out the cyst if an adequate plane is present. [21]
The outcome of surgical (or medical) management of gastrointestinal duplications is favorable. Metaplastic changes that have been reported in untreated gastrointestinal duplications can be prevented, depending on the location of the duplication, by appropriate surgical intervention. [22]
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