Hemorragia intestinal severa en una niña con duplicación ileal y breve reseña de la entidad / Severe hemorrhage intestinal in a child with ileal duplication and brief entity review

RESUMEN

Las duplicaciones intestinales son malformaciones congénitas poco comunes localizadas en el borde mesentérico del intestino delgado, particularmente en el íleon. Más del 60% de los casos son sintomáticas durante el primer año de vida y el resto en escolares y adultos. El amplio espectro de síntomas y signos inespecíficos que presentan, frecuentemente simulan otras enfermedades. Entre las complicaciones destaca la hemorragia gastrointestinal que llega, ocasionar anemia severa y shock, como el caso que describimos de una niña de 11 años de edad, que presentó durante 15 meses severas evacuaciones sanguinolentas intermitentemente acompañadas de dolor abdominal intenso y anemia. Los niveles de hemoglobina llegaron hasta 6 g/dL requiriendo en varias ocasiones hemotransfusión. Múltiples diagnósticos y exámenes fueron realizados y finalmente la gammagrafía con Tc99m mostró mucosa gástrica ectópica; mediante laparotomía se encontró una duplicación intestinal en el íleon terminal. Se analiza esta entidad y su importancia de considerarla en el diagnóstico diferencial en cualquier tipo de sangrado del tubo digestivo (AU)

ABSTRACT

Intestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularly in the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adulthood. The wide spectrum of symptoms and unspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most noteworthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndrome and intense abdominal pain over 15 months. In this patient, hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Using a laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding of the digestive tube is discussedIntestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularlyin the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adult hood. The wide spectrum of symptoms andunspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most note worthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndromeand intense abdominal pain over 15 months. In this patient,hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Usinga laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding ofthe digestive tube is discussed (AU)