Gastrointestinal duplications: Management pitfalls

ABSTRACT

We report a case requiring operative treatment because it involved, on different occasions, a duplication cyst of the duodenum, unilateral pulmonary sequestration and gastric duplication as separate surgical problems. This case concerns a seven-month-old female infant who presented with intestinal obstruction and abdominal mass. During an exploratory laparotomy, a duodenal duplication cyst was discovered and excised. An associated gastric duplication cyst was missed because of failure to palpate the stomach during the laparotomy. In this instance, the stomach appeared normal on inspection, a key point for discussion and analysis in this paper. Investigation of postoperative fever following the first operation led to the detection of a pulmonary sequestration on the right side, which was excised later The gastric duplication, as yet undetected, only manifested itself in the second postoperative period as upper and lower gastrointestinal bleeding. The duplication cyst perforated into the stomach, and the stomach perforated into the peritoneal cavity, leading to an abscess cavity. These findings were not revealed by an ultrasound but were finally demonstrated by an upper gastrointestinal contrast study. The child underwent another laparotomy for excision of the gastric duplication. She is now well and thriving. This case report discusses the main lessons learned, together with a relevant literature review