Khanna Vikram, Khanna Kashish, Srinivas Maddur
Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India.
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2018 Mar 15;2018:bcr-2017-223848. doi: 10.1136/bcr-2017-223848.
A day-old neonate presented with bowel obstruction and an abdominal mass. Exploratory laparotomy revealed complete tubular midgut duplication from duodeno-jejunal junction up to terminal ileum which was communicating with the ileum distally. At the proximal end, another 5×5 cm duplication cyst was identified and excised. Postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3×3 cm foregut duplication cyst, but there were no respiratory symptoms. While being planned for an elective surgery, he presented at 6 months of age in emergency with massive bleed per-rectum and shock. He underwent Wrenn procedure without any injury to the normal bowel. The thoracic foregut duplication cyst was excised later. Total midgut duplication, though benign, may present with life-threatening haemorrhage if left untreated. Presence of one such lesion warrants a search for others. Mucosal stripping is a simple and safe alternate to resection.
一名出生一天的新生儿出现肠梗阻和腹部肿块。剖腹探查发现从十二指肠空肠交界处至回肠末端存在完整的管状中肠重复畸形，其远端与回肠相通。在近端，发现并切除了一个5×5厘米的重复囊肿。术后，症状缓解。随访期间，99m锝高锝酸盐单光子发射计算机断层扫描显示下腹部和右半胸有异位胃黏膜。胸部增强计算机断层扫描显示一个3×3厘米的前肠重复囊肿，但无呼吸道症状。在计划择期手术时，他6个月大时因直肠大量出血和休克急诊入院。他接受了雷恩手术，未对正常肠管造成任何损伤。后来切除了胸部前肠重复囊肿。总的中肠重复畸形虽然是良性的，但如果不治疗可能会出现危及生命的出血。存在一个这样的病变就需要寻找其他病变。黏膜剥脱术是一种简单安全的替代切除术的方法。
