Alimentary Tract Duplications Workup

  • Author: Gail E Besner, MD; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: May 1, 2012
 

Laboratory Studies

  • The standard admission laboratory studies, including CBC count and electrolyte levels, are usually appropriate.
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Imaging Studies

  • Radiography of the chest and abdomen: Preoperative diagnosis of alimentary tract duplications is often difficult. Symptoms usually include pain, and the alimentary tract duplication is often confused with other more common diagnoses, such as hypertrophic pyloric stenosis or intestinal obstruction secondary to intussusception or volvulus (see the images below). Plain radiographs of the chest and abdomen should be routinely obtained; however, because of the nonspecificity of their results, making a preoperative diagnosis on the basis of radiographic findings is unlikely. Abdominal radiograph of an infant with acute onsetAbdominal 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 obA small ileal duplication cyst causing complete obstruction of the small bowel (same patient as in the image above).
  • CT scanning of the chest and abdomen: CT scanning of the chest or abdomen is useful in establishing a diagnosis of alimentary tract duplication during the preoperative workup and may be used to evaluate for synchronous lesions once a single duplication has been identified.
  • Ultrasonography of the chest and abdomen: Like CT scanning, ultrasonography is also helpful in establishing a preoperative diagnosis and may similarly be used as a screening tool to address the 10-20% incidence of multiple lesions.
  • MRI: MRI may be necessary if neurologic symptoms of spinal cord compression are observed and if evidence of bony spinal abnormalities is present on plain film or CT scan findings. These symptoms may be indicative of intraspinal cysts.
  • Prenatal ultrasonography: Prenatal ultrasonography may occasionally detect enteric cysts.
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Histologic Findings

Histologic analysis of alimentary tract duplications typically reveals at least one outer muscular layer with an inner GI mucosal lining. The mucosal lining does not necessarily correspond to that of the adjacent normal intestine and may be composed of several different types of GI mucosa.

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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

  1. 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.

  2. Ladd WE. Duplications of the alimentary tract. South Med J. 1937;30:363.

  3. Gross RE. Duplications of the alimentary tract. In: The Surgery of Infancy and Childhood. 1953:221-245.

  4. Potter EL. Pathology of the Fetus and Newborn. Arnold Edward;1961.

  5. Stockman JM, Young VT, Jenkins AL. Duplication of the rectum containing gastric mucosa. JAMA. Jul 16 1960;173:1223-5. [Medline].

  6. Lavine JE, Harrison M, Heyman MB. Gastrointestinal duplications causing relapsing pancreatitis in children. Gastroenterology. Dec 1989;97(6):1556-8. [Medline].

  7. Williams WH, Hendren WH. Intrapancreatic duodenal duplication causing pancreatitis in a child. Surgery. May 1971;69(5):708-15. [Medline].

  8. 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].

  9. Flye MW, Izant RJ. Extralobar pulmonary sequestration with esophageal communication and complete duplication of the colon. Surgery. May 1972;71(5):744-52. [Medline].

  10. 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].

  11. 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].

  12. 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.

  13. Jewett TC Jr. Duplication of the entire small intestine with massive melena. Ann Surg. Feb 1958;147(2):239-44. [Medline].

  14. 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].

  15. O'Neil J, Rowe M. Duplications of the gastrointestinal tract. In: Essentials of Pediatric Surgery. St. Louis, Mo: Mosby Yearbook; 1995:520-5.

  16. Wrenn EL. Alimentary tract duplications. In: Holder, eds. Pediatric Surgery. Philadelphia, Pa: WB Saunders Co; 2000.

  17. Wrenn EL. Tubular duplication of the entire small intestine. Surg. 1962;52:484.

 
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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.
 
 
 
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