STUDY ON CLINICAL PROFILE , MANAGEMENT & OUTCOME OF GASTROINTESTINAL DUPLICATION IN CHILDREN

Autor: R. Dhinesh Kumar, C. Sankkarabarathi
Rok vydání: 2021
Předmět:
DOI: 10.5281/zenodo.5201680
Popis: INTRODUCTION: In 1733 Calder reported first case of gastrointestinal duplication. William E. Ladd coined the term gastrointestinal duplication in 1930, that included congenital anomalies of the foregut, midgut and hindgut. The incidence is of 1 in every 4500 autopsies. Enteric duplications are multiple in 10% to 20% cases. Duplication of the gastrointestinal intestinal tract occur any part of the alimentary tract from the tongue to the anus. Male have slightly more predominance than females. Gastrointestinal duplication will have a varied presentation. Ileum and the oesophagus are most commonly involved. Colonic duplication is rare and can present with diagnostic difficulties. Gastrointestinal duplication has presence of well developed coat of smooth muscle, intimately attached to the gastrointestinal tract in the mesentric region and show a common blood supply with the native bowel. Sometime it will have an epithelial lining representing some portion of the alimentary tract. AIM OF THE STUDY: 1. Analyzing the antenatally suspected gastrointestinal duplication postnatally and the associated anomalies. 2. Analyzing location of the duplication and the type of the duplication. 3. Analyzing the management of the gastrointestinal duplication, complication and outcome of the above. MATERIALS AND METHODS: STUDY POPULATION : Cases admitted and diagnosed as gastrointestinal duplication made on USG findings. NATURE OF STUDY : Prospective study. NO OF CASES : 20. STUDY PERIOD : August 2010 to February 2013. Selection criteria: Inclusion criteria: 1. All cases of antenatally suspected gastrointestinal duplication in the postnatal period. 2. All cases of foregut, midgut and hindgut duplication. 3. All cases of cystic and tubular gastrointestinal duplication. 4. All cases of communicating and non-communicating duplication. Exclusion criteria: 1. Bronchogenic cyst, 2. Omental cyst, 3. Mesentriccyst. METHODOLOGY: All the above patients were subjected to detailed history and clinical examination. Relevant investigations were performed like x-ray chest and abdomen, Ultrasonogram abdomen (USG), Computed tomography (CT), Magnetic resonance imaging (MRI) and gastrograffin study done if needed. The intraoperative findings like location of the duplication, the type of duplication, whether communicating or non-communicating, the number of duplication, resectability of the lesion analysed. The analysis of the procedures like excision of the duplication only, excision of the duplication along with the native bowel and end to end anastomosis, mucosal excision of the duplication done. The complication during the surgery and in the postoperative period are studied. These patients are followed up to the available period. The results were analysed and tabulated RESULTS: This study of Gastrointestinal duplication presented to Department of Paediatric surgery, Institute of Child health and health centre, Madras Medical College, Chennai was undertaken between August 2010 to February 2013. The following facts were obtained. During this study period, 20 patients who met the selection criteria were taken for analysis. Maximum number of cases are less than 1 year. In our study 18 cases are seen in less than one year of age. Among the cases presented less than 1 year, most of them presented between first day of birth to within 7 months. Maximum number of cases, 15 cases are male patients. Among the five cases who underwent antenatal USG, two cases were reported as cystic duplication, one case had dilated bowel loops. The most commonest presentation is the abdominal distension. Eight cases presented only with abdominal distension. On examination of the abdomen the commonest finding is the mass felt in the right illac fossa. Seven cases had palpable mass. Many patients had only duplication without associated anomaly. The commonest intraoperative finding is the ileal duplication, 12 cases had only ileal duplication. Among the operative procedure eight cases underwent excision of the cyst followed by six cases underwent resection of the duplication and end to end anastomosis. Two cases readmitted with features of adhesive obstruction. One case managed conservatively, other case had laproscopic adhesiolysis. CONCLUSION: A good antenatal ultrasound can pick up gastrointestinal duplication, requiring further evaluation and elective surgery. • Incidentally noted gastrointestinal duplication should be operated electively to avoid complications like bleeding and perforation from the ectopic gastric mucosa. • Most of the gastrointestinal duplication will present within 1 year of age. • Gastrointestinal duplication is more common in males. • Ileum is the most commonest site for gastrointestinal duplication. • Cystic and communicating type of gastrointestinal duplication are most common types of duplication. • Complete excision of the duplication should be aim of the surgery. • The identification of vascular pattern (type I/II) helps in removing the duplication without injuring the native bowel. • Thoracic duplication presenting with respiratory distress caries poor prognosis.
Databáze: OpenAIRE
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