Total midgut duplication: a ticking time bomb

Abstract

A day-old neonate presented with bowel obstruction and an abdominal mass. Exploratory laparotomy revealed complete tubular midgut duplication from duodeno-jejunal junction up to terminal ileum which was communicating with the ileum distally. At the proximal end, another 5×5 cm duplication cyst was identified and excised. Postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3×3 cm foregut duplication cyst, but there were no respiratory symptoms. While being planned for an elective surgery, he presented at 6 months of age in emergency with massive bleed per-rectum and shock. He underwent Wrenn procedure without any injury to the normal bowel. The thoracic foregut duplication cyst was excised later. Total midgut duplication, though benign, may present with life-threatening haemorrhage if left untreated. Presence of one such lesion warrants a search for others. Mucosal stripping is a simple and safe alternate to resection.

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

“…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.…”

“…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.…”

Thoracoabdominal duplication with hematochezia as an onset symptom in a baby: A case report

“…Zhang et al [ 8 ] suggested that attention should be paid to intestinal duplication in the abdominal cavity when mediastinal enterogenous cysts are noted, and vice versa . Khanna et al [ 9 ] also proposed that when a case of intestinal duplication is diagnosed, attention should be paid to whether there are concurrent duplications of other parts. Nazem et al [ 10 ] mentioned that there could be concurrent esophageal duplication cysts and small intestine duplication.…”

“…The postoperative prognosis is generally good, with few postoperative complications and a low recurrence rate. Khanna et al [ 9 ] reported that a neonate with total midgut duplication underwent staged surgery due to a poor general condition and long tubular duplication. The proximal cyst was excised in stage I. Postoperative reexamination revealed the presence of an enterogenous cyst in the mediastinum.…”