An unusual presentation of a cystic duplication of the sigmoid colon entirely lined with squamous epithelium.
ABSTRACT Alimentary tract duplications are rare congenital malformations that occur most commonly in the jejunoileal part of the gastrointestinal tract. Management of this pathologic condition is usually drawn up. We report a case of descending colonic communicating duplication in which clinical presentation and anatomopathologic results were unexpected. A slightly echogenic abdominal mass reaching 72 x 36 mm in the left flank was diagnosed in a female fetus during the third trimester ultrasound examination. At birth, volume of the mass rapidly evolved, and despite no intestinal obstruction was observed by compression of the adjacent gastrointestinal tract, abdomen was distended. Abdominal plain film showed a large air collection, and the barium enema demonstrated a slight leak of contrast in the aerated mass, suggesting a communication with the sigmoid colon. No other abnormalities were seen. The patient underwent surgery in emergency. The mass was then totally excised through an antimesenteric resection of the tubular tract joining cystic mass and sigmoid colon. A lateral suture of the colon was subsequently performed. The wall of the duplication is usually composed of a smooth muscle layer covered by an epithelium, mostly of intestinal type. Herein, we describe a descending colonic duplication completely lined with nonkeratinizing squamous epithelium. Therefore, the association of a colonic mucosa (of endodermic origin) and a squamous epithelium (derived from the ectoderm) in our case is an interesting finding and is not explained by the various theories. Furthermore, the clinical characteristics, diagnosis, and treatment of intestinal duplications are discussed with regard to literature.
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ABSTRACT: Alimentary tract duplications are rare congenital malformations with few reports of the antenatal sonographic appearance. Early diagnosis is of paramount importance to prevent complications. We present a case of a cystic gastric duplication diagnosed antenatally at 31 weeks' gestation, which was treated successfully. Simultaneously, we review all published cases of prenatally diagnosed enteric duplications.Prenatal Diagnosis 03/2000; 20(2):163-7. · 2.68 Impact Factor
Chapter: Gastrointestinal Duplications[show abstract] [hide abstract]
ABSTRACT: Gastrointestinal duplications are rare congenital lesions that can develop anywhere along the alimentary tract and may present in the newborn period as an abdominal mass. They are differentiated from other intraabdominal cystic lesions by the presence of a normal gastrointestinal mucosal lining. Multiple theories have been proposed to account for these lesions; however, no single theory adequately explains all the known duplications. They are most frequently single, tubular, or cystic and located on the mesenteric side of the native alimentary tract structure. Symptoms often are related to the location of the duplication; oral and esophageal lesions can create respiratory difficulties, whereas lower gastrointestinal lesions may cause nausea, vomiting, bleeding, perforation, or obstruction. Treatment is resection with care taken to protect the common blood supply of the native structures. Occasionally, a partial resection with mucosal excision is required to preserve intestinal mucosa. Copyright © 2000 by W.B. Saunders Company12/2005: pages 240-256;
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ABSTRACT: Duplications of the alimentary tract are rare congenital anomalies that could present a diagnostic as well as therapeutic challenge. Twenty-seven patients with duplications of the alimentary tract were treated at Childrens Hospital Los Angeles between 1961 and 1992. Ages ranged from a few days to 5 years (67% younger than 1 year). The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Three patients presented with gastric duplication, which was excised. The majority of the duplications were in the jejunum and ileum. All patients except one had primary resection of the duplication. One patient with a 45-cm tubular jejunal duplication was treated with mucosal stripping of the duplication. Five patients had cecal duplication, three patients presented with melena because of ectopic gastric tissue in the duplication, and two presented with intestinal obstruction. One of the latter patients presented with intussusception with cecal duplication as the leading point. Three patients with colonic duplication presented with abdominal pain and vomiting leading to excision of the duplication. Of the five patients with rectal duplication, three presented with chronic constipation. The other two patients presented elsewhere with perianal swelling, which eventually was drained because of a mistaken diagnosis of perianal abscess. Subsequently, these two patients came to us with persistent perineal fistula. In all our patients, rectal duplications were removed through a sacroperineal incision. The only patient in this series who died was a 6-week-old boy with gastric duplication; his death was attributed to an associated severe cardiac lesion.(ABSTRACT TRUNCATED AT 250 WORDS)Journal of Pediatric Surgery 10/1995; 30(9):1267-70. · 1.38 Impact Factor