Gupta Rahul, Kumar Ajay, Agrawal Liladhar, Bhandari Anu, Gupta Arun Kumar, Goyal Ram Babu
Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
Consultant JNU Medical College, Jaipur (Former Senior Professor SMS Medical College, Jaipur), Rajasthan, India.
J Indian Assoc Pediatr Surg. 2023 Mar-Apr;28(2):128-136. doi: 10.4103/jiaps.jiaps_108_22. Epub 2022 Nov 30.
Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life.
To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute.
It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications.
All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes.
Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases ( = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum ( = 17), followed by gallbladder ( = 6), appendix ( = 3), gastric ( = 1), jejunum ( = 1), esophagus ( = 1), ileocecal junction ( = 1), duodenum ( = 1), sigmoid ( = 1), and anal canal ( = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception ( = 6) was the most common, followed by intestinal atresia ( = 5), anorectal malformation ( = 3), abdominal wall defect ( = 3), hemorrhagic cyst ( = 1), Meckel's diverticulum ( = 1), and sacrococcygeal teratoma ( = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases.
GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract.
胃肠道重复畸形是一种罕见的先天性畸形,临床表现多样。它们通常在儿童期出现,尤其是在生命的头两年。
介绍我们在一家儿科外科三级护理教学机构处理胃肠道重复畸形(囊肿)的经验。
这是一项回顾性观察研究,于2012年至2022年在我们中心的儿科外科进行,针对胃肠道重复畸形。
分析所有患儿的年龄、性别、临床表现、影像学评估、手术治疗及预后情况。
32例患者被诊断为胃肠道重复畸形。该系列中男性略占优势(男:女≈4:3)。15例(46.88%)患者在新生儿年龄组;26例(81.25%)患者年龄在2岁以下。大多数病例(n = 23,71.88%)表现为急性起病。1例患者在膈肌两侧出现双重复囊肿。最常见的部位是回肠(n = 17),其次是胆囊(n = 6)、阑尾(n = 3)、胃(n = 1)、空肠(n = 1)、食管(n = 1)、回盲部(n = 1)、十二指肠(n = 1)、乙状结肠(n = 1)和肛管(n = 1)。存在多种合并症(畸形/手术病理情况)。肠套叠(n = 6)最为常见,其次是肠闭锁(n = 5)、肛门直肠畸形(n = 3)、腹壁缺损(n = 3)、出血性囊肿(n = 1)、梅克尔憩室(n = 1)和骶尾部畸胎瘤(n = 1)。4例与肠扭转有关,3例与肠粘连有关,2例与肠穿孔有关。75%的病例预后良好。
胃肠道重复畸形的表现因部位、大小、类型、局部肿块效应、黏膜形态及相关并发症而异。临床怀疑和影像学检查的重要性不可低估。需要早期诊断以预防术后并发症。治疗应根据重复畸形的类型及其与受累胃肠道的关系进行个体化处理。