Gastrointestinal duplications may occur anywhere from the mouth to the anus.
Symptoms may be related to compression of normal structures, such as respiratory distress from compression of the airway or compression of the bowel by a cystic duplication causing obstruction. Symptoms may be related to mass effect with pain or obstruction of the pancreatic duct or common bile duct with either pancreatitis or jaundice.
Symptoms may be caused by a mass lesion with subsequent torsion of the intestine.
Ectopic gastric mucosa may cause symptoms by acid production in areas where the mucosa is not structured to handle the acid load; this results in bleeding or perforation.
Symptoms may be related to a connection from a thoracoabdominal duplication to the spine with meningitis.
Duplications may be tubular or cystic.
Infection may cause a duplication to rapidly enlarge. This is most significant if the lesion is near the airway.
Treatment of duplications is complete resection if possible. In cases where complete resection is not possible the principles of treatment include drainage of the lesion into the gastrointestinal tract and removal or destruction of any ectopic gastric muscoa.
If the duplication has a spinal connection, this must be dealt with at the time of resection.
Duplications are located throughout the gastrointestinal tract from the mouth to the anus. They vary widely in size and are either spherical or tubular. They possess a well-developed layer of the smooth muscle and a mucous membrane lining derived from some part of the gastrointestinal tract. Most, but not all, lesions are attached to the gastrointestinal tract. Thoracic duplications may share a muscular wall with the esophagus or may lie in a distant position, whereas duplications in the abdomen usually share a muscular wall and lie in the mesentery of the gastrointestinal tract. Table 51-1 summarizes the location of duplications in a number of recently published series.
Distribution of Intestinal Duplications by Anatomic Site in Several Recent Large Series
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Table 51-1 Distribution of Intestinal Duplications by Anatomic Site in Several Recent Large Series
|Author ||Cervical ||Esophageal ||Thoracoabdominal ||Gastric ||Duodenal ||Small Intestinal ||Colonic ||Rectal ||Total |
|Bower ||0 ||15 ||1 ||8 ||4 ||34 ||12 ||2 ||76 |
|Gross ||1 ||13 ||3 ||2 ||4 ||32 ||9 ||4 ||68 |
|Grosfeld ||0 ||4 ||2 ||1 ||0 ||9 ||4 ||0 ||20 |
|Holcomb ||1 ||20 ||3 ||8 ||2 ||47 ||20 ||0 ||101 |
|Ilstad ||0 ||6 ||0 ||1 ||0 ||13 ||0 ||0 ||20 |
|Mellish and Koop ||1 ||6 ||2 ||1 ||0 ||18 ||6 ||4 ||38 |
|Stringer ||0 ||12 ||6 ||7 ||3 ||17 ||3 ||6 ||54 |
|Percent of Total ||1% ||20% ||5% ||7% ||3% ||45% ||14% ||4% || |
Multiple theories exist as to the embryologic cause of duplications. None of these theories can completely explain all types and their associated anomalies. It is possible that some combination of these theories ...