Duplicidad intestinal con diagnóstico ecográfico. Presentación de un caso

La duplicación intestinal es una afección poco frecuente que se diagnostica y resuelve durante los dos primeros años de vida. Pueden ser diverticulares, quísticas o tubulares, comunicadas y no comunicadas. Los síntomas varían con el tipo, tamaño, localización y mucosa que los tapiza. Este trabajo tiene como objetivo presentar el caso de una paciente pediátrica con diagnóstico de duplicidad intestinal ileal, en que las pruebas de imagen aportaron al diagnóstico definitivo. Se trata de una paciente femenina de 16 meses, que presentó dolor abdominal tipo cólico difuso, intermitente, heces sanguinolentas, distención abdominal e irritabilidad. En radiografía de abdomen simple se evidenció distensión de asas intestinales como niveles hidroaéreos y presencia de gas en recto. En ultrasonido se constató imagen quística hacia hipocondrio derecho, en íntimo contacto con asa intestinal adyacente, signo de la doble pared y nivel líquido-líquido. Se sugirió el diagnóstico de duplicidad intestinal ileal, que fue confirmado con biopsia, posterior a cirugía realizada. Es la ecografía la prueba de primera opción en el diagnóstico de esta afección. Muestra el signo de la doble pared con una capa ecogénica interna (epitelio) y una capa hipoecogénica externa que corresponde a las capas musculares. Los métodos de estudios imagenológicos son de vital importancia para su diagnóstico, es el ultrasonido abdominal quien proporciona un diagnóstico certero, siendo inocuo para el paciente.

Intestinal duplication is a rare condition that is diagnosed and resolves within the first two years of life. They can be diverticular, cystic or tubular, communicating and non-communicating. The symptoms vary with the type, size, location and mucosa that covers them. This research aims to present the case of a pediatric patient diagnosed with ileal intestinal duplication, in which imaging tests contributed to the definitive diagnosis. This is a 16-month-old female patient who presented with diffuse, intermittent colicky abdominal pain, bloody stools, abdominal distention, and irritability. A simple abdominal X-ray revealed distention of the intestinal loops, such as air-fluid levels and the presence of gas in the rectum. Ultrasound revealed a cystic image towards the right hypochondrium, in close contact with the adjacent intestinal loop, double wall sign and fluid-fluid level. The diagnosis of ileal intestinal duplication was suggested, which was confirmed with a biopsy after surgery. Ultrasound is the test of first choice in the diagnosis of this condition. It shows the double wall sign with an inner echogenic layer (epithelium) and an outer hypoechoic layer corresponding to the muscle layers. The methods of imaging studies are of vital importance for its diagnosis, it is the abdominal ultrasound that provides an accurate diagnosis, being harmless for the patient.

Duplicidad intestinal y diagnóstico diferencial prenatal de lesiones quísticas intraabdominales / Intestinal duplication and prenatal differential diagnosis of intra-abdominal cysts

Resumen ANTECEDENTES: Las duplicaciones del aparato digestivo son una variante poco frecuente de malformación congénita. Si bien la mejora de los equipos de ecografía ha aumentado la tasa diagnóstica, solo el 30% se diagnostican antes del nacimiento. El diagnóstico diferencial de lesiones quísticas intraabdominales es amplio e incluye, por ejemplo, a los quistes de ovario, colédoco, mesenterio o pseudoquistes de meconio. El tratamiento es quirúrgico mediante la resección y restauración de la continuidad intestinal. CASO CLÍNICO: Paciente de 32 años, con un embarazo previo y en el segundo trimestre del actual, con sospecha de un quiste de duplicación intestinal. El estudio genético no evidenció anomalía alguna. La lesión, de morfología quística tubular, fue aumentando progresivamente de tamaño conforme avanzaban las semanas de embarazo. En la semana 39 se indicó, por diabetes gestacional insulinodependiente, la inducción del parto. Nació un varón, asintomático, mediante parto eutócico, sin complicaciones. La ecografía abdominal, resonancia magnética nuclear y estudio del tránsito intestinal del periodo neonatal temprano confirmó el diagnóstico prenatal de sospecha. Mediante una laparoscopia exploradora, a las dos semanas de vida se practicó la resección del defecto que se reportó como: duplicación intestinal ileal, sin comunicación con la luz intestinal. El curso posoperatorio fue favorable. CONCLUSIONES: El diagnóstico prenatal de quistes de duplicación en el aparato digestivo está en aumento debido a la mejoría en las técnicas de diagnóstico prenatal. La valoración multidisciplinaria es decisiva para procurar una adecuada vigilancia médica del embarazo y del recién nacido.

Abstract BACKGROUND: Duplications of the digestive tract are a rare variant of congenital malformation that can occur anywhere in the digestive tract. Although improved ultrasound equipment has increased the diagnostic rate, only 30% are diagnosed before birth. The differential diagnosis of intra-abdominal cystic lesions is broad and includes, for example, cysts of the ovary, common bile duct, mesentery or meconium pseudocysts. Treatment is surgical by resection and restoration of intestinal continuity. CLINICAL CASE: 32-year-old patient, with a previous pregnancy and in the second trimester of the current pregnancy, with suspicion of an intestinal duplication cyst. The genetic study did not reveal any abnormality. The lesion, of tubular cystic morphology, progressively increased in size as the weeks of pregnancy progressed. Induction of labour was indicated in week 39 due to insulin-dependent gestational diabetes. An asymptomatic male was born by euthecological delivery, without complications. Abdominal ultrasound, nuclear magnetic resonance imaging and intestinal transit study of the early neonatal period confirmed the suspected prenatal diagnosis. By means of exploratory laparoscopy, at two weeks of life, resection of the defect was performed, which was reported as: ileal intestinal duplication, without communication with the intestinal lumen. The postoperative course was favourable. CONCLUSIONS: Prenatal diagnosis of duplication cysts in the digestive tract is increasing due to improved prenatal diagnostic techniques. Multidisciplinary assessment is crucial to ensure adequate medical surveillance of the pregnancy and the newborn.

Quiste enterogénico y agenesia renal en la edad adulta / Enterogenic cyst and renal agenesis in adulthood

Introducción: Los quistes enterogénicos son malformaciones producidas durante el período de diferenciación y desarrollo embriológico del intestino primitivo. Objetivo: Presentar una malformación digestiva infrecuente en la edad adulta. Caso clínico: Paciente de 58 años que acude por dolor abdominal y aumento de volumen en hipogastrio. Al examen físico se palpa masa en hipogastrio de 15 cm de diámetro. La tomografía axial computarizada simple y contrastada mostró una masa tumoral en la excavación pélvica hipodensa con densidad de 18 UH, pared gruesa, de 2 cm, que realza con el contraste y agenesia renal derecha. El estudio anatomo-patológico informa quiste enterogénico. Discusión: La clínica de las duplicaciones intestinales es inespecífica, el dolor abdominal recurrente y la presencia de masa abdominal, son frecuentes. El diagnóstico preoperatorio de las duplicaciones intestinales es infrecuente, depende de la disponibilidad de estudios de imagen y la sospecha clínica. Es infrecuente la asociación de quiste enterogénico y agenesia renal. Conclusión: Se presenta una paciente masculino con una masa pélvica de etiología dudosa y agenesia renal derecha, en el que se diagnosticó un quiste enterogénico. La asociación de quiste enterogénico y agenesia renal es una malformación rara en el adulto(AU)

Introduction: Enterogenic cysts are malformations produced during the period of differentiation and embryological development of the primitive intestine. Objective: To report an rare digestive malformation in adulthood. Clinical case report: A 58-year-old patient came for abdominal pain and increased volume in the hypogastrium. On physical examination, a 15-cm diameter mass was palpated in the hypogastrium. Simple and contrast computerized axial tomography showed a tumor mass in the hypodense pelvic excavation with a density of 18 HU, a thick wall of 2 cm, which was enhanced with contrast and right renal agenesis. The anatomo-pathological study reports an enterogenic cyst. Discussion: The symptoms of intestinal duplications are nonspecific, recurrent abdominal pain and the presence of an abdominal mass are frequent. The preoperative diagnosis of intestinal duplications is occasional, it depends on the availability of imaging studies and clinical suspicion. The association of enterogenic cyst and renal agenesis is uncommon. Conclusion: A male patient is reported, with a pelvic mass of doubtful etiology and right renal agenesis, in whom an enterogenic cyst was diagnosed. The association of enterogenic cyst and renal agenesis is a rare malformation in adults(AU)

Duplicación intestinal como causa inusual de sangrado digestivo bajo

Intestinal duplications are rare congenital anomalies that can occur anywhere along the gastrointestinal tract. Diagnosis and treatment may be difficult in some patients. We present the case of a patient who was hospitalized for rectal bleeding, with a history of recurrent abdominal pain, in whom intestinal duplication was finally diagnosed as a surgical finding. At the same time we analyze the clinical characteristics, management and treatment of intestinal duplications

Las duplicaciones intestinales son anomalías congénitas raras que pueden ocurrir en cualquier lugar a lo largo del tracto gastrointestinal. El diagnóstico y tratamiento puede ser difícil en algunos pacientes. Presentamos el caso de un paciente hospitalizado por sangrado rectal, con antecedente de dolor abdominal recurrente, en quien se diagnosticó una duplicación intestinal como hallazgo quirúrgico. A la vez analizamos las características clínicas, manejo y tratamiento

Oclusión intestinal por duplicación intestinal: diagnóstico y tratamiento en urgencias / Intestinal occlusion by intestinal duplication: diagnosis and treatment in the emergency

Las duplicaciones intestinales son anomalías congénitas; se han descrito a lo largo de todo el tracto digestivo con una presentación clínica inespecífica. Reportamos el caso clínico de un paciente de 83 años intervenido quirúrgicamente por una oclusión intestinal por duplicación intestinal del íleon terminal. Discutimos la presentación clínica, estudios de imagen, procedimiento quirúrgico y resultados del tratamiento. Revisamos la literatura actual pertinente por ser un hallazgo etiológico de oclusión intestinal poco frecuente.

The intestinal duplication are congenital abnormalities; have been described throughout the digestive tract with a nonspecific clinical presentation. We report the clinical case of a patient of 83 years underwent surgery for an intestinal occlusion by intestinal duplication of the terminal ileum. We discuss the clinical presentation, image studies, surgical procedure and results of treatment. We review the current literature relevant to be a finding etiological diagnosis of intestinal occlusion rare.

Duplicación de intestino delgado / Small bowel duplicity

Las duplicaciones intestinales son malformaciones congénitas poco frecuentes. Pueden localizarse desde la boca al ano. En general son asintomáticas, aunque pueden complicarse y manifestarse como hemorragia digestiva o abdomen agudo en aquellos casos en que se localiza a nivel abdominal. Esto obliga a tenerlo en cuenta como diagnóstico diferencial ante estos cuadros. En adultos, el diagnóstico suele darse de manera casual en el acto operatorio. Si bien la conducta es quirúrgica, con resección de la duplicación, ya sea total o parcial, en casos asintomáticos no complicados, esta conducta es controversial. Se presentan tres casos asintomáticos no complicados, diagnosticados casualmente en operaciones abdominales por otras causas, en la que se optó por tratamiento conservador. Dos de los casos fueron operados en el Hospital Regional del Luque y el tercero en el Instituto Nacional del Cáncer. Se hace una revisión del tema.

Intestinal duplications are infrequent congenital malformations. They can be located since the mouth to the anus. Generally they are asymptomatic, although they can be complicated and manifest themselves as a gastrointestinal bleeding or an acute abdomen in those cases that they are located in an abdominal level. These cases compel us to think in them as a differential diagnosis. In adults, the diagnosis usually occurs by chance during the surgical procedure. Although the behavior is surgical, with a partial or total resection of the duplication, it is controversial in those asymptomatic or not complicated cases. It is presented three asymptomatic and not complicated cases which were diagnosed by chance during abdominal surgeries for other causes, and where we chose a conservative treatment. Two out of the three cases were operated in the Hospital Regional de Luque and the third case was operated in the Instituto Nacional del Cáncer. It is made a review of the subject.

A Case of Intestinal Duplication Cyst Identified as Pathological Lead Point in a Child with Recurrent Intussusception / 대한소아소화기영양학회지

Intestinal duplication cysts are characterized by the attachment to some part of the gastrointestinal tract with which a blood supply is shared, and have an epithelial lining resembling some part of the alimentary tract. A 15-month-old female was admitted to our hospital with cyclic irritability, vomiting, and blood-tinged stool. The results of an ultrasound showed an ileocolic intussusception and a 1.3 cm cystic mass had double-wall sign and a Y-configuration with an adjacent ileal loop. She had a past history of two ileocolic intussusceptions. The cystic mass was considered to be a pathologic lead point, so resection and end-to-end anastomosis was performed. The gross and histologic evaluation of the specimen demonstrated a 2.4x2.4 cm cystic mass containing yellow mucoid fluid and the cyst wall was lined with intestinal and gastric mucosa and enclosed by a layer of muscle, which was shared with the adjacent ileum.

Coincident Occurrence of Intestinal Duplication Cyst and Type I and Type II Intestinal Atresias

The association of intestinal duplication and intestinal atresia is very rare. A case of intestinal duplication associated with Type I and Type II intestinal atresias is reported, and the relevant literature pertaining to the causation of these lesions is discussed. To the best of our knowledge, this case seems to be the first report in Korean literatures.

Intestinal Duplication in Childhood

PURPOSE: Intestinal duplication is a rare congenital anomaly that may be found anywhere from the mouth to the anus. The clinical presentation varies depending on the anatomic location or the size of the duplication, and the presence of the ectopic gastric tissue. The aim of this study was to analyze the clinical characteristics, the diagnostic and therapeutic methods, the location, the anatomic type and the associated anomalies of intestinal duplication. METHODS: We reviewed the medical record of eighteen patients with duplication of the alimentary tract and these patients had been treated at Kyungpook National University Hospital from July 1995 through October 2007. RESULTS: There were 9 boys and 9 girls. Their ages ranged from 3 days to 15 years. The most common symptom was abdominal pain. The duplicated segment acted as a leading point of intussusception in 3 cases. Two patients had melena. The duplications were cystic in fifteen cases and three others were tubular. In twelve cases, the lesions were located in the ileum; two other cases were located in the anal canal, one other was located in the in the transverse colon, another was located in the transverse and descending colon, one was located in the in the duodenum and one was located in the jejunum. Ultrasonography, computed tomography and barium enema were helpful as diagnostic tools. Three cases were diagnosed by prenatal ultrasonography. Associated anomalies were documented in four cases. All the patients underwent surgery. A duplicated lesion was lined with ectopic gastric mucosa in only one case. One patient still suffers from short bowel syndrome as a result of volvulus. CONCLUSION: The early operative treatment of intestinal duplication is safe and effective to prevent complications. In patients with intussusception, duplication should be considered as one of the causes of the leading point of intussusception.

Duplicação intestinal e teratoma retroperitoneal na infância: relato de caso / Intestinal duplication and retroperitoneal teratoma in childhoof: a case report

Os autores apresentam um caso de duplicação intestinal e teratoma retroperitoneal em uma paciente de sete anos de idade com massa palpável e dor abdominal a esclarecer, que foi submetida a estudo radiológico convencional, ultra-sonografia, tomografia computadorizada e posterior laparotomia exploradora. O estudo anatomopatológico constatou duplicação intestinal e teratoma maduro. Na literatura médica existente não foi encontrado nenhum caso semelhante.

The authors present a case of intestinal duplication and retroperitonealteratoma in a 7-year-old patient with evident mass and abdominal pain to explain; that it was submitted to study conventional X-ray, ultrasonography, computed tomography and subsequentexploiting laparotomia. The anatomopathological study verified intestinal duplication and ripe teratoma. In the existent medical literature it was not found any similar case.

Two-trocar laparoscope in the diagnosis and treatment of intestinal duplication / 中国微创外科杂志

Objective To explore the diagnosis and treatment of intestinal duplication by means of laparoscope. Methods 9 cases suspected intestinal duplication before operation underwent intraperitoneal exploration through two-trocar laparoscope. Patients diagnosed as intestinal duplication were performed by enterectomy and end-to-end intestinal anastomosis outside abdominal cavity through a 10mm trocar. Results All cases were operated on under lapascope with a mean operative time of 80min(30min～110min).The postoperative hospital stay was 4d～5d . No complications occurred. Conclusions Two-trocar laparoscope is an effective method to diagnose and treat intestinal duplication.

Clinical Characteristics and Management of Congenital Intestinal Duplication

PURPOSE: Intestinal duplications are rare congenital malformations that may require surgical intervention. This study attempted to elucidate the clinical characteristics and the management of this disease. METHODS: We reviewed the experience of 13 intestinal duplications confirmed with postoperative pathologic reports from January 1989 to September 2001 at Seoul National University Children's hospital. RESULTS: Nine patients were female and 4 were male. Ages ranged from a few days to 5 years (61.4% younger than 1 year). The most common symptom was a vomiting. The major diagnostic method recorded was abdominal ultrasonography. The location of the 12 cystic duplicaions was the ileum in 7 cases, the anus in 2 cases, the duodenun in 1 case, the jejunun in 1 case and the rectum in 1 case. A tubular duplication from the transverse colon to the anus with communication was found in one case. The diameter of the cystic duplications averaged 3.45 cm, and the average length of the tubular duplication was 40 cm. Treatment used was resection and anastomosis of the involved intestine in 8 cases, septostomies in 2, anoplasty in 1, marsupialization in 1 and transanal excision in 1. There were no postoperative complications or mortality experienced. Gastric mucosa was found in 3 of 7 ileal duplications, small intestinal mucosa was found in the duodenal duplication, and squamous epitheliums were found in the rectal and anal duplications. CONCLUSION: Congenital intestinal duplication presents as an intestinal obstruction or an abdominal mass in childhood. Abdominal ultrasonography is a major diagnostic method and surgical intervention is mandatory.

Diagnosis and Treatment of Intestinal Duplication in Children by Laparoscopy / 中国微创外科杂志

Objective To evaluate the clinical value of laparoscopy in the diagnosis and treatment of intestinal duplication for children. Methods From June 2002 to May 2007, 15 children (aged 27 days to 10 years) with intestinal duplication were treated by laparoscopy in our hospital. The lesions were explored by laparoscopy, and then pulled out through the umbilical hole or the trocar hole at the right lower abdomen. The anastomosis was performed outside the abdominal cavity. Results The operation was successfully accomplished in all the patients. No serious postoperative complications occurred. Among the cases, end-to-end anastomosis was performed on 12 patients, resection of the duplicated intestine on 2, and demucosation on 1. Simultaneously, appendectomy was performed on 2 cases, and ring suturing for inguinal hernia on 1. The patients were followed up for 3-18 months (mean, 12 months), during which no patients had symptoms of intestinal adhesion (abdominal distension, vomiting), hemorrhage, or incisional hernia. Conclusions Laparoscopy is effective and reliable with a high diagnostic rate and low complication rate in the diagnosis and treatment of intestinal duplication for children.