Higashidate Naruki, Sakamoto Saki, Saikusa Nobuyuki, Koga Yoshinori, Masui Daisuke, Nakahara Hirotomo, Nakamura Misa, Saikusa Mamoru, Kinoshita Masahiro, Kaji Tatsuru
Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Surg Case Rep. 2023 Aug 9;9(1):141. doi: 10.1186/s40792-023-01728-2.
Duplication of the alimentary tract can occur in any of its parts. For duodenal duplication, complete resection is particularly difficult when the ampulla of Vater is on the duplicated lumen and a deliberate management is necessary.
A 0-day female baby was referred to our department due to abdominal distention. The X-ray examination showed dextrocardia and opacity of the liver on the left side and abdominal ultrasonogram revealed remarkable intestinal dilatation. Therefore, urgent laparotomy was performed on the day of birth. Complete situs inversus of the abdominal organs was revealed, and the origin of the jejunum was on the left side and was accompanied by tubular intestinal duplication. The origin of the duplicated intestine was at the pancreatic head's dorsal area. There were two points of type Шa atresia on the ileum. Therefore, we spared the duplicated intestine with a length of 3 cm to secure the passage of the biliary and pancreatic juices by a functional-side-to-side anastomosis with a 45-mm Endo-GIA™ camel load (Medtronic, Minneapolis, MN, USA). The ileum was transected at the distal side of the atresia point, and end-to-end jejunoileostomy was performed. Postoperative gastrointestinal series revealed remnants of the duplicated alimentary tract on the dorsal area of the stomach.
Identifying the position of the ampulla of Vater is crucial in the surgery of alimentary tract duplication with duodenal involvement. However, in the present case, it was difficult to identify whether the ampulla of Vater was on the true or duplicated lumen, and we had to spare the duplicated duodenum. Stapler anastomosis could be performed safely even in neonatal cases.
消化道的任何部位都可能发生重复畸形。对于十二指肠重复畸形，当十二指肠乳头位于重复管腔内时，完整切除尤为困难，需要进行慎重处理。
一名0日龄女婴因腹胀被转诊至我科。X线检查显示右位心且左侧肝脏密度增高，腹部超声检查显示明显的肠道扩张。因此，在出生当天进行了紧急剖腹手术。术中发现腹部器官完全反位，空肠起始部位于左侧，并伴有管状肠重复畸形。重复肠管的起始部位于胰头背侧区域。回肠有两处Шa型闭锁。因此，我们保留了一段3厘米长的重复肠管，通过使用45毫米的Endo-GIA™ 驼峰型吻合器（美国美敦力公司，明尼阿波利斯，明尼苏达州）进行功能性侧侧吻合，以确保胆汁和胰液的通畅。在闭锁点远侧切断回肠，并进行端端空肠回肠吻合术。术后胃肠道造影显示胃背侧区域有重复消化道残留。
在涉及十二指肠的消化道重复畸形手术中，确定十二指肠乳头的位置至关重要。然而，在本病例中，很难确定十二指肠乳头是位于真腔还是重复管腔内，因此我们不得不保留重复的十二指肠。即使在新生儿病例中，也可以安全地进行吻合器吻合。
