Bowel conservation in a case of giant jejuno-ileal duplication

Abstract

The management of very long tubular bowel duplications poses a special challenge to even the most skilled surgeon. In these cases, mucosal stripping is usually employed. We report a novel case of a two-year-old boy, with 120 cm long jejuno-ileal duplication, wherein, bowel salvage was achieved, utilizing the Bianchi principle, originally described for bowel lengthening in cases of short bowel syndrome.

Long Tubular Duplication of the Small Intestine – Lessons Learnt from a Common Presentation of a Rare Disease

“…reported the use of Bianchi principle to excise the duplicated bowel by dividing one leaf of the mesentery. [ 3 ] In our case, the removal of whole duplicated mucosa was possible because of the use of Wrenn principle. Dissection of the common wall would have been difficult by Bianchi technique.…”

“…Preoperative presentation is usually GI bleed,[ 5 6 7 ] features of sepsis,[ 6 ] or abdominal pain. [ 3 ] The abdominal lump has been detected in cases with associated cystic duplications. [ 3 5 ]…”

“…Preoperative radiological findings have usually identified associated cystic duplication. [ 3 5 ] Occasionally, long tubular duplication has been picked up by preoperative sonography as a large well-defined cystic lesion with thick walls with gut signature and internal debris[ 6 ] – the patient in this report was sick with features of GI bleed and sepsis – accumulation of the contents within the duplicated bowel might have caused sepsis and enabled identification of the duplicated bowel.…”

“…[ 1 ] The presence of HGM or a history of bleed mandates the complete removal of the duplicated mucosa. Two surgical techniques described by Bianchi[ 2 3 ] and Wrenn[ 4 5 ] have been utilized in dealing with this anomaly.…”

Total midgut duplication: a ticking time bomb

“…In the second surgery, we were able to perform the Wrenn procedure without incurring any injury to the native normal bowel while preserving its blood supply. Sham et al 2 have also reported a similar case where they excised two large cystic duplications of the proximal jejunum and used the Bianchi’s principle for the distal tubular duplication segment.…”