Yang Shao-Bo, Yang Hong, Zheng Shan, Chen Gong
Department of Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
World J Clin Cases. 2021 Aug 26;9(24):7261-7268. doi: 10.12998/wjcc.v9.i24.7261.
Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract, whereas thoracoabdominal duplications only account for approximately 2% of all alimentary tract duplication cases. Many symptoms, including abdominal pain, abdominal distension, vomiting, gastrointestinal bleeding, chest discomfort, chest pain, and shortness of breath, may be present in patients with abdominal or thoracic duplication.
A 10-mo-old infant, with a free previous medical history, was admitted to our hospital with melena three times in 6 d. Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities, spina bifida, meningomyelocele towards the posterior mediastinum, and possible concurrent infection. Upper gastroenterography indicated intestinal malrotation. A laparoscopic abdominal examination was performed, and the operation was intraoperatively converted to laparotomy. This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication. The intestinal duplications in the abdomen and large part of the thorax were excised. The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa. The infant recovered well and was discharged 1 wk after the surgery. A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced.
Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.
消化道重复畸形是一种罕见的先天性疾病，可发生于消化道的任何部位，而胸腹段重复畸形仅占所有消化道重复畸形病例的约2%。腹部或胸部重复畸形的患者可能出现多种症状，包括腹痛、腹胀、呕吐、胃肠道出血、胸部不适、胸痛和呼吸急促。
一名10个月大的婴儿，既往无病史，因6天内出现3次黑便入院。胸椎增强磁共振成像显示多个颈胸段椎体畸形、脊柱裂、后纵隔脊膜脊髓膨出以及可能并发感染。上消化道造影显示肠旋转不良。进行了腹腔镜腹部检查，术中改为剖腹手术。该病例术中诊断为胸腹段肠重复畸形。切除了腹部和大部分胸部的肠重复畸形。术后病理检查结果证实该病例为消化道重复畸形，且部分重复畸形包含胃黏膜。婴儿恢复良好，术后1周出院。术后3个月的随访计算机断层扫描显示脊髓脊膜膨出，而后纵隔囊肿明显缩小。
如果儿童疑似腹部肠重复畸形并以便血为首发症状，应考虑胸腹段重复畸形。
