DUPLICATIONS OF THE ALIMENTARY-TRACT IN INFANTS AND CHILDREN

Duplications of the alimentary tract are rare congenital anomalies tha t could present a diagnostic as well as therapeutic challenge. Twenty- seven patients with duplications of the alimentary tract were treated at Childrens Hospital Los Angeles between 1961 and 1992. Ages ranged f rom a few days to 5 years (67% younger than 1 year). The most common s ymptoms were nausea and vomiting, and the most common sign was a palpa ble abdominal mass. Three patients presented with gastric duplication, which was excised. The majority of the duplications were in the jejun um and ileum. All patients except one had primary resection of the dup lication. One patient with a 45-cm tubular jejunal duplication was tre ated with mucosal stripping of the duplication. Five patients had ceca l duplication, three patients presented with melena because of ectopic gastric tissue in the duplication, and two presented with intestinal obstruction. One of the latter patients presented with intussusception with cecal duplication as the leading point. Three patients with colo nic duplication presented with abdominal pain and vomiting leading to excision of the duplication. Of the five patients with rectal duplicat ion, three presented with chronic constipation. The other two patients presented elsewhere with perianal swelling, which eventually was drai ned because of a mistaken diagnosis of perianal abscess. Subsequently, these two patients came to us with persistent perineal fistula. In al l our patients, rectal duplications were removed through a sacroperine al incision. The only patient in this series who died was a 6-week-old boy with gastric duplication; his death was attributed to an associat ed severe cardiac lesion. In patients with gastrointestinal symptoms, duplications should be considered in the differential diagnosis. if th e intestinal duplication is short, the lesion can be removed with the adjacent normal bowel. For long duplications, mucosal stripping of the duplication is performed to preserve the adjacent bowel. The common b lood supply shared by the duplication and the bowel must be carefully protected to avoid sacrifice of the bowel. The presence of heterotopic gastric mucosa in the duplication negates internal drainage of the le sion into the adjacent bowel. Copyright (C) 1995 by W.B. Saunders Comp any.