Alimentary Tract Duplications Treatment & Management

Author: Gail E Besner, MD; Chief Editor: Marleta Reynolds, MD more...

Updated: May 1, 2012

What would you like to print?

Surgical Therapy
Preoperative Details
Intraoperative Details
Postoperative Details
Follow-up
Complications
Outcome and Prognosis
Future and Controversies
Show All

Surgical Therapy

Surgical treatment of alimentary tract duplications is largely dictated by the specific anatomic location of the lesion and its relation to normal anatomic structures. Attention to vital structures (eg, bile duct, named vessels) must be considered when attempting to resect an intestinal duplication cyst.

Preoperative Details

Although the diagnosis of alimentary tract duplication is often not made until the patient is in the operating room, preoperative preparation is based on standard surgical principles of adequate hemodynamic status and the use of appropriate preoperative medications as deemed necessary (eg, antibiotics). The use of bowel prep should be considered as part of the preoperative routine.

Intraoperative Details

In most instances, cystic duplications can be completely excised. Resection of normal intestine must often accompany removal of the lesion because of the intimate attachment of the common wall or because isolated resection of the cyst would compromise blood flow to the adjacent intestinal segment (see the image below). An alternative approach involves marsupialization of the cystic structure. This consists of a partial cystectomy combined with mucosal stripping of the remaining cyst wall to preserve normal anatomy.

The intimate association of the jejunal duplication cyst with normal jejunum requires a limited small-bowel resection as definitive surgical therapy.

Resection of tubular duplications follows the same principles as cystic duplications but may pose a more complicated venture, especially when the patient has a long tubular segment or total intestinal duplication involving the upper GI tract and small bowel (incidence of gastric mucosa is high). Again, marsupialization combined with mucosal stripping becomes an important tool in the surgical treatment of these entities. Tubular duplication of the hindgut may be left in situ if adequate drainage (by surgically joining the 2 lumens) or mucosal stripping of the defunctionalized portion can be achieved.

Postoperative Details

Postoperative care is considered to be routine and is directed at the specific surgical intervention undertaken.

Follow-up

Because of the significant incidence of synchronous lesions, follow-up imaging (eg, CT scanning, ultrasonography) of additional body cavities should be performed in the event that the diagnosis of alimentary tract duplication was made intraoperatively.

Complications

Complications related to the discovery of an intestinal duplication cyst include bowel obstruction and hemorrhage. Because most intestinal duplications are cystic and appear in the ileum, requiring a limited resection, complications related to surgical intervention are typically nonspecific and include postoperative bleeding, infection, and bowel obstruction. However, in patients with large tubular duplications, injury to the normal intestine with resultant short bowel syndrome must be considered. Other complications include scattered reports of intestinal carcinomas found within duplication cysts.

Outcome and Prognosis

Although current literature does not specifically address the prognosis and outcome related to the diagnosis of alimentary tract duplications, the overall outcome is generally accepted as favorable.

Future and Controversies

As with many types of surgical interventions, several reports have been published promoting the use of minimally invasive instrumentation (ie, laparoscopy) for the definitive diagnosis and treatment of alimentary tract duplications.^{[10, 11]}

Contributor Information and Disclosures

Author

Gail E Besner, MD John E Fisher Endowed Chair in Neonatal Reseach, Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine

Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Hilfiker, MD, PhD Chief, Division of Pediatric Surgery, Assistant Professor, Department of Surgery, University of California at San Diego Medical Center

Mary L Hilfiker, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science and American College of Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael G Caty, MD Professor of Surgery and Pediatrics, State University of New York at Buffalo; Consulting Staff, Department of Pediatric Surgery, Children's Hospital of Buffalo

Michael G Caty, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, and Association for Surgical Education

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD Professor of Surgery, Northwestern University, The Feinberg School of Medicine; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Marc Michalsky, MD, to the development and writing of this article.

References

Fitz RH. Persistent omphalomesenteric remains: their importance in the causation of intestinal duplication, cyst formation and obstruction. Am J Med Sci. 1884;88:30-57.
Ladd WE. Duplications of the alimentary tract. South Med J. 1937;30:363.
Gross RE. Duplications of the alimentary tract. In: The Surgery of Infancy and Childhood. 1953:221-245.
Potter EL. Pathology of the Fetus and Newborn. Arnold Edward;1961.
Stockman JM, Young VT, Jenkins AL. Duplication of the rectum containing gastric mucosa. JAMA. Jul 16 1960;173:1223-5. [Medline].
Lavine JE, Harrison M, Heyman MB. Gastrointestinal duplications causing relapsing pancreatitis in children. Gastroenterology. Dec 1989;97(6):1556-8. [Medline].
Williams WH, Hendren WH. Intrapancreatic duodenal duplication causing pancreatitis in a child. Surgery. May 1971;69(5):708-15. [Medline].
Holcomb GW 3rd, Gheissari A, O'Neill JA Jr, Shorter NA, Bishop HC. Surgical management of alimentary tract duplications. Ann Surg. Feb 1989;209(2):167-74. [Medline].
Flye MW, Izant RJ. Extralobar pulmonary sequestration with esophageal communication and complete duplication of the colon. Surgery. May 1972;71(5):744-52. [Medline].
Lee KH, Yeung CK, Tam YH. Laparoscopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg. Sep 2000;35(9):1291-3. [Medline].
Schleef J, Schalamon J. The role of laparoscopy in the diagnosis and treatment of intestinal duplication in childhood. A report of two cases. Surg Endosc. Sep 2000;14(9):865. [Medline].
Heiss K. Intestinal duplications. In: Oldham KT, Columbani PM, Foglia RP, eds. Surgery of Infants and Children: Scientific Principles and Practice. Philadelphia, Pa: Lippincott-Raven; 1997:1265-74.
Jewett TC Jr. Duplication of the entire small intestine with massive melena. Ann Surg. Feb 1958;147(2):239-44. [Medline].
Jewett TC Jr, Walker AB, Cooney DR. A long-term follow-up on a duplication of the entire small intestine treated by gastroduplication. J Pediatr Surg. Apr 1983;18(2):185-8. [Medline].
O'Neil J, Rowe M. Duplications of the gastrointestinal tract. In: Essentials of Pediatric Surgery. St. Louis, Mo: Mosby Yearbook; 1995:520-5.
Wrenn EL. Alimentary tract duplications. In: Holder, eds. Pediatric Surgery. Philadelphia, Pa: WB Saunders Co; 2000.
Wrenn EL. Tubular duplication of the entire small intestine. Surg. 1962;52:484.

Illustration depicting the many locations where alimentary tract duplications may be found.

Abdominal radiograph of an infant with acute onset of bilious vomiting and abdominal distention secondary to a duplication cyst at the terminal ileum.

A small ileal duplication cyst causing complete obstruction of the small bowel (same patient as in the image above).

The intimate association of the jejunal duplication cyst with normal jejunum requires a limited small-bowel resection as definitive surgical therapy.

View Table List

Read more about Alimentary Tract Duplications on Medscape