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LETTER TO EDITOR
Year : 2010  |  Volume : 4  |  Issue : 2  |  Page : 69-70

Jejunal duplication cyst


Department of Paediatric Surgery, B J Wadia Children Hospital, Parel, Mumbai - 400 012, India

Date of Web Publication24-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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.78278

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How to cite this article:
Hambarde S, Bendre P. Jejunal duplication cyst. Ann Nigerian Med 2010;4:69-70

How to cite this URL:
Hambarde S, Bendre P. Jejunal duplication cyst. Ann Nigerian Med [serial online] 2010 [cited 2021 Jan 24];4:69-70. Available from: https://www.anmjournal.com/text.asp?2010/4/2/69/78278

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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2.Shah A, More B, Buick R. Pyloric duplication in a neonate: A rare entity. Pediatr Surg Int 2005;21:220-2.   Back to cited text no. 2
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4.La Quaglia MP, Feins N, Eraklis A, Hendren WH. Rectal duplications. J Pediatr Surg 1990;25:980-4.   Back to cited text no. 4
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8.Kumar A, Kumar J, Gadodia A, Chumber S, Aggarwal L. Multiple short-segment colonic duplications. Pediatr Radiol 2008;38:567-70.   Back to cited text no. 8
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9.Pinter AB, Schubert W, Szemledy F, Göbel P, Schäfer J, Kustos G. Alimentary tract duplications in infants and children. Eur J Pediatr Surg 1992;2:8-12.   Back to cited text no. 9
    
10.Berrocal T, Torres I, Gutierrez J, Prieto C, del Hoyo ML, Lamas M. Congenital anomalies of the upper gastrointestinal tract.Radiographics 1999;19:855-72.   Back to cited text no. 10
    
11.Hur J, Yoon CS, Kim MJ, Kim OH. Imaging features of gastrointestinal tract duplications in infants and children: From oesophagus to rectum. Pediatr Radiol 2007;37:691-9.   Back to cited text no. 11
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12.Stern LE, Warner BW. Gastrointestinal duplications. Semin Pediatr Surg 2000;9:135-40.   Back to cited text no. 12
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13.Brown RL, Azizkhan RG. Gastrointestinal bleeding in infants and children: Meckel's diverticulum and intestinal duplication. Semin Pediatr Surg 1999;8:202-9.  Back to cited text no. 13
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14.Puligandla PS, Nguyen LT, St-Vil D, Flageole H, Bensoussan AL, Nguyen VH, et al. Gastrointestinal duplications. J Pediatr Surg 2003;38:740-4.   Back to cited text no. 14
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15.Faigel DO, Burke A, Ginsberg GG, Stotland BR, Kadish SL, Kochman ML. The role of endoscopic ultrasound in the evaluation and management of foregut duplications. Gastrointest Endosc 1997;45:99-103.   Back to cited text no. 15
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16.Kuo HC, Lee HC, Shin CH, Sheu JC, Chang PY, Wang NL. Clinical spectrum of alimentary tract duplication in children. Acta Paediatr Taiwan 2004;45:85-8.   Back to cited text no. 16
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17.Segal SR, Sherman NH, Rosenberg HK, Kirby CL, Caro PA, Bellah RD, et al. Ultrasonographic features of gastrointestinal duplications. J Ultrasound Med 1994;13:863-70.   Back to cited text no. 17
    
18.Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE, Wallach MT. CT of the duodenum: An overlooked segment gets its due. Radiographics 2001;21:S147-60.   Back to cited text no. 18
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19.Macpherson RI. Gastrointestinal tract duplications: Clinical, pathologic, etiologic, and radiologic considerations. Radiographics 1993;13:1063-80.   Back to cited text no. 19
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20.Stringer MD, Spitz L, Abel R, Kiely E, Drake DP, Agrawal M, et al. Management of alimentary tract duplication in children. Br J Surg 1995;82:74-8.  Back to cited text no. 20
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21.Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, McGowan MA, Martin LW. Duplications of the alimentary tract: Clinical characteristics, preferred treatment, and associated malformations. Ann Surg 1988;208:184-9.  Back to cited text no. 21
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22.Karnak I, Ocal T, Senocak ME, Tanyel FC, Buyukpamukcu N. Alimentary tract duplications in children: Report of 26 years' experience. Turk J Pediatr 2000;42:118-25.  Back to cited text no. 22
    




 

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