DUPLICATIONS OF THE ALIMENTARY-TRACT - CLUES TO THE MISSING LINKS

This is a review of the past 10 years' experience with duplications of the alimentary tract at the All India Institute of Medical Sciences, New Delhi, during which 14 infants and children with a total of 15 dup lications were treated. Esophageal duplications represented the majori ty of cases (55%). Certain unexplained associations in this malformati on led the authors to perform (1) detailed histological studies of the duplication cysts to seek explanation for the high incidence of gastr ic mucosa in their walls and its presence in duplications even in the distal parts of the gut, and (2) myelography and postmyelography compu terized axial tomography scans to substantiate the spinal pathology. T hree of four myelograms in patients with esophageal duplications showe d an intraspinal pathology, and all three had vertebral defects. Histo logical evaluation of the cyst wall showed that gastric mucosa was the most common ectopic tissue in the walls of the cysts, and the tissues were in various primitive stages of differentiation. On the basis of these data, the authors hypothesize that (1) the embryonic endoderm of the entire alimentary tract has the potential to develop into gastric mucosa at the time of inception of duplications, which explains the h igh incidence of gastric mucosa and its presence in duplications even in the distal parts of the gut, (2) persistence of the embryonic relat ionship of the esophagus with the vertebral column is responsible for the high incidence of vertebral defects in esophageal duplications. Th e results of myelography in this series also support the theory of spl it notochord syndrome. Copyright (C) 1994 by W.B. Saunders Company