History and Physical Examination

The presentation of a gastrointestinal (GI) duplication depends on its size and location.^[13]

Cervical duplications

Patients with cervical duplications present with respiratory distress that may be life-threatening and necessitates rapid diagnosis and treatment.

Thoracic and thoracoabdominal duplications

Respiratory distress caused by airway compression may be noted in younger children; however, in older patients, heartburn or melena has been reported, which is probably caused by the presence of gastric mucosa in one third of patients with thoracic and thoracoabdominal duplications.

Gastric duplications

Patients usually present when younger than 1 year with vomiting, poor feeding, failure to gain weight, and a palpable mass upon physical examination. Hypertrophic pyloric stenosis is often a misdiagnosis in such infants. The mucosal lining of the cysts is often gastric and can lead to melena or hematemesis.^[14]Massive hemorrhage from gastric duplications can occur even in elderly patients.^[15]

Duodenal duplications

About 15% of these duplications contain ectopic gastric mucosa, which predisposes the patient to ulceration. Peptic ulceration may lead to painless GI hemorrhage that can progress to perforation. Duplications may extend into the liver or even transdiaphragmatically. These are generally diagnosed after onset of high intestinal obstruction or hemorrhage that may commonly be accompanied by icterus or pancreatitis.

Pyloric duplications

These are extremely rare and can present with signs of gastric outlet obstruction.^[16]

Small-intestine duplications

Clinical presentation depends on the type, size, location, and mucosal lining of the duplication.^[17]Small cystic duplications can be anchor points for intussusception or can result in volvulus, whereas long tubular duplications with proximal communication drain poorly, and retention of intestinal contents can obstruct adjacent intestine. Distal communication is more common and is more difficult to diagnose than proximal communication.

Gastric mucosa in a duplication can lead to ulceration and perforation. The diagnosis is often not established before surgery. Cecal duplications are rare and may present as an appendicular abscess, a tumor, or necrotizing enterocolitis.^[18]

Colonic duplications

Cystic colonic duplications either are asymptomatic or present as abdominal masses that may be accompanied by pain. Bleeding may be observed despite the lower prevalence of ectopic gastric mucosa in colon duplications. Newborns may present with volvulus or acute intestinal obstruction. Tubular colonic duplications are usually asymptomatic, but severe esthetic problems are observed with the duplicated genitalia.

Rectal duplications

Presenting signs of colonic or presacral duplications may include constipation, rectal bleeding, hematochezia, rectal prolapse, hemorrhoids, fistula-in-ano, and perirectal abscess.^[11]Rectal duplications may present as unusual external cysts.^[19]

Workup

Spătaru RI, Lupuşoru MOD, Şerban D, Ivanov M, Iozsa DA. Alimentary tract duplications in children - a 15 years' experience. Rom J Morphol Embryol. 2021 Jul-Sep. 62 (3):751-756. [QxMD MEDLINE Link]. [Full Text].
Yang MC, Duh YC, Lai HS, Chen WJ, Chen CC, Hung WT. Alimentary tract duplications. J Formos Med Assoc. 1996 May. 95 (5):406-9. [QxMD MEDLINE Link].
Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Padilla-Armendariz DP, Saldaña-Rodriguez JA, Leyva-Alvizo A, Rodarte-Shade M, et al. Esophageal Duplication Cysts in 97 Adult Patients: A Systematic Review. World J Surg. 2022 Jan. 46 (1):154-162. [QxMD MEDLINE Link].
Nobuhara KK, Gorski YC, La Quaglia MP, Shamberger RC. Bronchogenic cysts and esophageal duplications: common origins and treatment. J Pediatr Surg. 1997 Oct. 32 (10):1408-13. [QxMD MEDLINE Link].
Iyer CP, Mahour GH. Duplications of the alimentary tract in infants and children. J Pediatr Surg. 1995 Sep. 30 (9):1267-70. [QxMD MEDLINE Link].
Kumar A, Kumar J, Gadodia A, Chumber S, Aggarwal L. Multiple short-segment colonic duplications. Pediatr Radiol. 2008 May. 38 (5):567-70. [QxMD MEDLINE Link].
Jeziorczak PM, Warner BW. Enteric Duplication. Clin Colon Rectal Surg. 2018 Mar. 31 (2):127-131. [QxMD MEDLINE Link].
Puligandla PS, Nguyen LT, St-Vil D, Flageole H, Bensoussan AL, Nguyen VH, et al. Gastrointestinal duplications. J Pediatr Surg. 2003 May. 38 (5):740-4. [QxMD MEDLINE Link].
Stern LE, Warner BW. Gastrointestinal duplications. Semin Pediatr Surg. 2000 Aug. 9 (3):135-40. [QxMD MEDLINE Link].
Shah A, More B, Buick R. Pyloric duplication in a neonate: a rare entity. Pediatr Surg Int. 2005 Mar. 21 (3):220-2. [QxMD MEDLINE Link].
La Quaglia MP, Feins N, Eraklis A, Hendren WH. Rectal duplications. J Pediatr Surg. 1990 Sep. 25 (9):980-4. [QxMD MEDLINE Link].
Xiang L, Lan J, Chen B, Li P, Guo C. Clinical characteristics of gastrointestinal tract duplications in children: A single-institution series review. Medicine (Baltimore). 2019 Nov. 98 (44):e17682. [QxMD MEDLINE Link]. [Full Text].
Nagar H. Duplications of the gastrointestinal tract. Isr Med Assoc J. 1999 Dec. 1 (4):254-6. [QxMD MEDLINE Link].
Barlev DM, Weinberg G. Acute gastrointestinal hemorrhage in infancy from gastric duplication: imaging findings. Emerg Radiol. 2004 Feb. 10 (4):204-6. [QxMD MEDLINE Link].
Klimopoulos S, Gialvalis D, Marougas M, Zotos D, Orfanos N, Roussakis A, et al. Unusual case of massive hemorrhage of a gastric duplication cyst in a very advanced age. Langenbecks Arch Surg. 2009 Jul. 394 (4):745-7. [QxMD MEDLINE Link].
Sharma D, Bharany RP, Mapshekhar RV. Duplication cyst of pyloric canal: a rare cause of pediatric gastric outlet obstruction: rare case report. Indian J Surg. 2013 Jun. 75 (Suppl 1):322-5. [QxMD MEDLINE Link]. [Full Text].
Brown RL, Azizkhan RG. Gastrointestinal bleeding in infants and children: Meckel's diverticulum and intestinal duplication. Semin Pediatr Surg. 1999 Nov. 8 (4):202-9. [QxMD MEDLINE Link].
Temiz A, Oğuzkurt P, Ezer SS, İnce E, Gezer HÖ, Hiçsönmez A. Different clinical presentations, diagnostic difficulties, and management of cecal duplication. J Pediatr Surg. 2013 Mar. 48 (3):550-4. [QxMD MEDLINE Link].
Karaman I, Karaman A, Arda N, Cakmak O. External cystic rectal duplication: an unusual presentation of rectal duplication cyst. Singapore Med J. 2007 Nov. 48 (11):e287-8. [QxMD MEDLINE Link].
Gandhi D, Garg T, Shah J, Sawhney H, Crowder BJ, Nagar A. Gastrointestinal duplication cysts: what a radiologist needs to know. Abdom Radiol (NY). 2022 Jan. 47 (1):13-27. [QxMD MEDLINE Link].
Hur J, Yoon CS, Kim MJ, Kim OH. Imaging features of gastrointestinal tract duplications in infants and children: from oesophagus to rectum. Pediatr Radiol. 2007 Jul. 37 (7):691-9. [QxMD MEDLINE Link].
Pintér AB, Schubert W, Szemlédy F, Göbel P, Schäfer J, Kustos G. Alimentary tract duplications in infants and children. Eur J Pediatr Surg. 1992 Feb. 2 (1):8-12. [QxMD MEDLINE Link].
Berrocal T, Torres I, Gutiérrez J, Prieto C, del Hoyo ML, Lamas M. Congenital anomalies of the upper gastrointestinal tract. Radiographics. 1999 Jul-Aug. 19 (4):855-72. [QxMD MEDLINE Link].
Macpherson RI. Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics. 1993 Sep. 13 (5):1063-80. [QxMD MEDLINE Link].
Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE, Wallach MT. CT of the duodenum: an overlooked segment gets its due. Radiographics. 2001 Oct. 21 Spec No:S147-60. [QxMD MEDLINE Link].
Liu R, Adler DG. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound. 2014 Jul. 3 (3):152-60. [QxMD MEDLINE Link].
Gao Y, Chen N, Zhong Y, Wang W, Zhou X, Shao F, et al. Study on the Application of Ultrasonic Image Analysis Technology Combined with the Analysis of Intestinal Nervous System in the Treatment of Intestinal Duplication in Children. World Neurosurg. 2020 Jun. 138:749-757. [QxMD MEDLINE Link].
Faigel DO, Burke A, Ginsberg GG, Stotland BR, Kadish SL, Kochman ML. The role of endoscopic ultrasound in the evaluation and management of foregut duplications. Gastrointest Endosc. 1997 Jan. 45 (1):99-103. [QxMD MEDLINE Link].
Kuo HC, Lee HC, Shin CH, Sheu JC, Chang PY, Wang NL. Clinical spectrum of alimentary tract duplication in children. Acta Paediatr Taiwan. 2004 Mar-Apr. 45 (2):85-8. [QxMD MEDLINE Link].
Segal SR, Sherman NH, Rosenberg HK, Kirby CL, Caro PA, Bellah RD, et al. Ultrasonographic features of gastrointestinal duplications. J Ultrasound Med. 1994 Nov. 13 (11):863-70. [QxMD MEDLINE Link].
Jehangir S, Ninan PJ, Jacob TJ, Eapen A, Mathai J, Thomas RJ, et al. Enteric duplication in children: Experience from a tertiary center in South India. J Indian Assoc Pediatr Surg. 2015 Oct-Dec. 20 (4):174-8. [QxMD MEDLINE Link].
Karnak I, Ocal T, Senocak ME, Tanyel FC, Büyükpamukçu N. Alimentary tract duplications in children: report of 26 years' experience. Turk J Pediatr. 2000 Apr-Jun. 42 (2):118-25. [QxMD MEDLINE Link].
Stringer MD, Spitz L, Abel R, Kiely E, Drake DP, Agrawal M, et al. Management of alimentary tract duplication in children. Br J Surg. 1995 Jan. 82 (1):74-8. [QxMD MEDLINE Link].
Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, McGowan MA, Martin LW. Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations. Ann Surg. 1988 Aug. 208 (2):184-9. [QxMD MEDLINE Link].
Patiño Mayer J, Bettolli M. Alimentary tract duplications in newborns and children: diagnostic aspects and the role of laparoscopic treatment. World J Gastroenterol. 2014 Oct 21. 20 (39):14263-71. [QxMD MEDLINE Link].
Ren HX, Duan LQ, Wu XX, Zhao BH, Jin YY. Laparoscopic resection of gastric duplication cysts in newborns: a report of five cases. BMC Surg. 2017 Apr 12. 17 (1):37. [QxMD MEDLINE Link]. [Full Text].
Izumi H, Yoshii H, Abe R, Mukai M, Nomura E, Ito H, et al. Successful laparoscopic resection for gastric duplication cyst: a case report. J Med Case Rep. 2019 Jul 19. 13 (1):240. [QxMD MEDLINE Link]. [Full Text].
Bulotta AL, Stern MV, Moneghini D, Parolini F, Bondioni MP, Missale G, et al. Endoscopic treatment of periampullary duodenal duplication cysts in children: Four case reports and review of the literature. World J Gastrointest Endosc. 2021 Oct 16. 13 (10):529-542. [QxMD MEDLINE Link]. [Full Text].
Gjeorgjievski M, Manickam P, Ghaith G, Cappell MS. Safety and Efficacy of Endoscopic Therapy for Nonmalignant Duodenal Duplication Cysts: Case Report and Comprehensive Review of 28 Cases Reported in the Literature. Medicine (Baltimore). 2016 May. 95 (22):e3799. [QxMD MEDLINE Link].
Sauer B, Staritz M. [The double pylorus - a rare endoscopic finding]. Dtsch Med Wochenschr. 2012 Feb. 137 (8):368-70. [QxMD MEDLINE Link].

Media Gallery

Jejunal duplication in a newborn. Intraoperative image demonstrates a cystic structure found on the antimesenterial side of the jejunum. A segmental resection was performed and the jejunum anastomosed.

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