vol. 10. no. june 2004€¦ · vol. 10. no. 1. june 2004 a clinical study of intestinal duplication...
TRANSCRIPT
9
Vol. 10. No. 1. June 2004
A Clinical Study of Intestinal Duplication
Tae Woo Kim, M.D., Poong Man Jung, M.D.
Department of Surgery, College of Medicine, Hanyang University
Seoul, Korea
Intestinal duplication is a rare congenital anomaly. The diagnostic approach is difficult because of the differences in its location and clinical presentation. To evaluate the diagnostic as well as the therapeutic approaches in children, the medical records of 20 patients
with intestinal duplications which had been operated upon from July 1980 to October 2002 were analyzed, retrospectively. The range of age was from 1 day to 11 years. The variables, such as age, sex, clinical presentation, diagnostic method, localization, anatomic type, trea
tment, complication, and combined anomalies were analyzed. Most of the cases were presented as incidental finding. The majority of the duplications except hindgut were cystic type. Treatment included segmental intestinal resection, excision of the lesion without intestinal
resection, and septotomy. Seventy-five percent of the patients were detected before 1 year of age. The anatomic type of the lesion was closely related with its location. The cases of hindgut were almost always tubular type except 1 case. Clinical presentation was related to
age, location, and anatomic type. There were no specific diagnostic methods. Perfect localization and application of appropriate operation are the most important requirements for successful treatment. (J Kor Assoc Pediatr Surg 10(1):9-16), 2004.
Index Words: Duplimtion. Intestine, Gastrointestinal tract
Correspondence : Poong Man lung, MD., Department of Surg
ery, College of Medicine, Hanyang University Hospital, 17
Haengdang-dong, Sungdang-Gu, Seoul 133-792, Korea
Tel; 02) 2290-8450, FAX; 02) 2281-0224 E-mail;[email protected]
~ i=-~91 R A1.c- 2004\15:. 6~ 1O~ lJ'-T<>lP'l 7~J1~ All 20~} ~0}914 ~§j ~1l1 ~~r:J1§j<>llAl T~5'1:ctg.
<{i ~Jl~ Acls=.s.. -(:=':~-71] ~{!S:]-i=:- ~~o]q.
~A~ 1f-~]~ "&121 7]7~1f-s..1f-F~ "5Jtr-<>l] 0]i'..7]lJ}A1 ~:§}
-tl~1 <>1-'=:. 1f--'t101jJ,~y. ~A~W 'T ~q. ~PJ ~AJ.g- T-s.. T 5-, ~~, *~, ~jl1 ~Al, AJ!Jj1~ ~ 01 ~1-'2-y. rH1f-~.g- ~
B.-<4 7~*~AJ 'T~~{!:i!} ~~7,:lA} ~:i!}s.. ~B.-S:]-i=:- 7z3-'i'-7} 'e§q . .<fi~~ ojcl 7}A1 7HH~,01 ~-'2-y. o}~7!}A1s=. t§:§{o} 71] 'j1{O~A1A1 ~i'~ ~Acl01q. ~ ~T~ ojc~ 7}A1 ~AJ %AJ % Y.E}l-~uj o~cl AJ7]011A~ B8~ol ~7Ro}7] uJltr-01] ~B.- ~
~lli<4 -'2-s.. <>1 c1,'t 7,Pcl ~ t~ 0 l= o}-i=:- AJ ~*%011 rH ~ ~ AJ <4 Jl~~ A1~~o}9~q.
10 ::1::o}9-1-i!} :;(-1110:r:! ~11.:2:. 2004\1
Table 1. Clinical Characteristics
Case Sex/Age Location Type Symptom Diagnosis Treatment Combine anomaly 1 F/11yr Jejunum Cystic Bloody stool Intraoperative finding Resection None 2 F/7m Ileum Cystic Intussusception Intraoperative finding Resection None 3 F/20d Ileum Cystic Intestinal obstruction Intraoperative finding Resection None 4 F/5m Anorectum Tubular Double anus Sinogram Excision None 5 M/5yr Jejunum Cystic Bloody stool Intraoperative finding Resection None
6 M/2m Ileum Cystic Intestinal obstruction Barium-enema Resection None
7 M/5m Ileum Cystic Intussusception Intraoperative finding Resection None
8 M/4yr Ileum Cystic Intestinal obstruction Intraoperative finding Resection Ileal stenosis
9 M/9m Ileum Cystic Incidental Intraoperative finding Resection Wilms' tumor
10 F/2m Ileum Cystic Intussusception Barium-reduction Resection None
11' M/1m Ileum Cystic Intestinal obstruction Intraoperative finding Resection None
12 F/2m Rectum Tubular Incidental Intraoperative finding Septotomy Cloacal exstrophy, etc
13 M/1d T-colon Cystic Incidental Intraoperative finding Excision Omphalocele major, etc
14 F/1d Esophagus Tubular Incidental Autopsy Diaphragmatic hernia, etc 15 M/2m Ileum Cystic Abdominal mass Computed tomography Resection None 16 M/1d Ileum-colon Tubular Incidental Intraoperative finding Excision, Imperforate anus,
Septotomy conjoined twin, etc 17 M/3yr Anorectum Tubular Double anus Sinogram Excision 3,4 toe malposition
18 M/10d Ileum Cystic Abdominal mass Ultrasonography Resection None
19 F/2yr Anorectum Tubular Double anus Sinogram Excision None
20 M/2m Ileum Cystic Intussusception Air-reduction Resection None
19RO\~ 7-%PJi-El 2002\~ lO-'?diJ}:Aj Z-j\~ %~- ~oJrH~-_llL
-1",'ljJ~joJIAI <tl J+fr9] iO~91"'~ 9]A~"I1 91 til ~,~'l ~Ili
iCJ.1 1J7i¥1 I!J"i1 9} !f-'(j~- ~~l \if'O-jz! 1 "i191 ,±oloJ]Al ~l
A~i1 % 21 "i191 ?l-'6''Y-'6'''I1 tiltl *~ jl~% J,ltB'6J'iJ,c~.
012"11_"'-"'1 1"11 ul~ol ,:i%i"- ~JAI§.9,-"-uj ~I'± 9:HH' 4"11
"IIAj c~g, %1'1: 71i@ IQi*"I1 An "-AI 711'Y~% -~'6loj z!
Jtl- 2r:]9}jl io]jl -\Zlg- <:(lqg-p.=- llA-l]S5l:j-. Aj~~c 'JO}7} 12
"il (60 %), oj617~ 8"i1 (40 %)iC- ~JoI°ilAj 7,ci: m~ \f-_"'-* Q'iJ,cJ (lEI, 2).
'1l¥l91 1PW 015: 1"il,t~J 2"i1, :;,FJ 12"i171 'U'l;(1': cll
01 1;- <tl -1.l:6~"IJAlc -WN 27119] ?l1;-.\l-%,01 -1\-J,loJl -;<OIl
t}'lN cl~J :\"il, 01 %' 1"iloJl"'j1': ~nr Wl'l!f-!f-Ej z! cl AJ
01] :(i~ ~-~~*o] ~~515~:LJl "6J* ~~-lf-~17} 3oj]7} ~lSi
c} Ct:j).
ol%' 4"i1;- c},;:_ §'!f¥i 11"il uJilC-oJl ,,~ ~c _~AI ~1\l6j
7H-ty~% Ajt~iij-~ ~-~6--ty*oj 91%% 2}~ii]-~J._Jl 201]~ E-]
L~q-l~]Al z1-z]- AJ~~~H5-it} ~7JLH %$1~ {J-~ :;zlJtl-2r:lt>1 Fe1-
T~% A]tM ~Jl ~-'tl'X-jC1 2z} T~ .{::;;iolj),l i1-~~'i3'-~%
~ cJA19~ ~i'~, Ad~, ~l,:} %"l,:}, :utJ~1 ]:JJ-~, ~1(!9-] .tf-]5;],
BH1f-~-0~ %Dj, T~ uJ']lj, 1f~~, %~~ 7jDj ~~oJl f-lii}O:j
*B _Jl~% -2i-5H S:.A} -11-~ ii]-~J.-r}.
'l:!'8 'IliC-1': A~+ UHl 0ll'ioJl z!,hl 1J-,/-11 6"i19),2 1
711%!oJJAI 1,.111 nly}o] 9"i1, VIJ!",Ei 5AII77J7C17~ 3"11, 5"iI ol'iJ
tl-\'-~r'l~ {,U,j-S'_,c IS"iI"lIAj 'fAdiij (cystic tnJe)% q E} LH ~J]'I .q SC oJl '117m 1 "II Q} ~c 'if (hindgut)"i] 'II ~]11 5"11
°ll},j,c 'tPd'"J (tubular type)ol'l;(cr .
.qSCOII '11~]11 1"11i.'- "E ~c ~"'I !(J"1"-r8l1"-L.J0} rrl~"I1
T~~' !-j t~~ ~ 1 ~1 ~*.!f-~:L~5~- A}nJ +~] 1f-;';:H~: %B~
615=. "6]--1 1/301] ~1~]~- {l-l,:}f@9~ ~-?;-~~o] l,l[Zl 5] Sirl.
EE~ s}-1- !:9jDjAd1f-~, qJZ-l~"'tl-?;J, ~§j~olAJ~ (intestinal
malrotation), 'li{F6'Z1ll1', 471121 "I?l% 7}7C1,c c1-"I1l-'6'
(jJolysplenia).§- § '!ft}'l{ c}.
~~-Q.] ~-~~*.f':- 13°j 06- AJ-l-91~o] 91Si'ii -7cl.'(7} 801]
'iJ,i.'-rll §I'if 'l1'2~Y~"I1 L~l'i°l '117]11 4o!IoJlJ,j;,c AH;~*-6'°1
"leading point"7} sloj "J%'ll'i5'.a- 'lLoJI ll'i-~.a- AI·E'6r
-B E11-'1- Q1 : AJ- %*~.9-1 <iJAJ~ Jl~ 11
Table 2. Age and Sex of 20 Patients at Initial Pres-entation
Male Female Total
<1m 4 2 6 1 m - 1yr 5 4 9
1 - 5yr 2 3
>5yr 2
Total 12 8 20
oj ~~ W Y ~H!Jl y.uj:zl 4ojl~ JJ8~01 AjAJ AJtl:g ~ ~-o}oj A~zl }!jl~Ul1~011 T£, *-¥-Il~~ %~1 %AJol ~J~q.
*-¥- %:iL17} ~Al'El 7cH-7} 2ojl, JJ8~01 -t'-AJ011 ~J~tj 20jl 5'..-T- 5A~1 °VJQj 'i1~OmJl 'l'l.~% -T~s.. 1-B-'tl-o}~q. JJ8 \liol :§FJ011 ~J~tj 11~ %011 ~A~ ~ %~ 71"5J Ul1~011 -'j''i1-o1 ~u'El 1oj1~ A1191-o}Jl~ 5'..-T- y~ LJAl AJ}!jl~oly.
*-¥- % JI1 ~ -T~s.. 111-'tl -o} ~ L}. ~ ~ :8 U BJ 'i:l ~s..=; :iL17} ~:z1'El 2ojl011 Al *-¥- &gTIj-~} *-¥- ~~§j- U% ~oa% ~
Table 3. Location and Type of 21 Duplications in 20 Patients
Location Cystic Tubular
Esophagus 1
Jejunum 2
lIeum* 12
Colon 2
Anorectum 3
Total 15 6 * One patient had synchronous two cystic duplications at ileum.
1O~ ~oHAl 5x4em, A~ ~ 27B-~ ~oH1Al 7x6em 3.71 ~J,L} (J'il n ~~ AJ%~% ~1{l-oH1 l:l}% Aj*~ ~ -t'-71
Aj*~g Al~~~ 7Cl-'j'-7} ZfZf lojl1Q °l~Jl y.uj:zl 9ojl-c :8 U~ 7B*~% Al~~-o}oj y~ ~;;:!J1} S:~ {3A} ~:iLHAl AJ %*%~% ~~-o}~q. ~ ~0}011Al-c ~fAJ"5J~l q~Aj AJ %*°1 :§:l u~-"\1 ~~1 011 3 x 2 em 3.71 s.. 27B Qj JJ8 \li 01 2 em 71~~ -T-Jl %A1011 .'f1~l-o}~q (J'il 2). j\lli-c 140jl 5'..-T-
Fig. 1. Intestinal duplications presented as an abdominal mass: AI and All, operative findings; 8, ultrasonographic finding of AI, measureing 5.43 x 4.69cm; C, computed tomographic finding of All, 7 x 6cm.
12
Fig. 2. Operative finding of the two ileal duplications. Fig. 3. Operative finding of the tubular anorectal duplication from the anus up to the sigmoid colon.
Fig. 4. Operative findings of the long tubular duplication: A, tubular duplication with separate blood supply from the ileum to the sigmoid colon; 8, completly divided duplicated intestine.
T"'Ji§ g y.E} l.]1o.1Ai ~~g ~~~ )(J -¥--If:-~:<11~g A1~~
-o}~q. 2oJ1011 Ai %\171<3"~ g 7}A1Jl ~)s;J,-cr-n 44-& -%l.~~1
%-0J (Wilms' tumor)i'} :§j)(J~~% (ileal stenosis) 01s;J,q.
rH)(J011 ~~o1 1l~1~ 3oJ1 .2.-'f- A~.f~A1 %\171i§ uJltr-
011 ~u~ 7~*~g A1~~~ ~q-s-Ai ~~~ ~)(J011 T"'Ji§~
~~01 ~s;J,Lj loJ1-c 1l~-8-1~PJi'} {} sj-°J011 1l~1~ lj3.\t
(left sided gallbladderl% %\1-o}~.2..uj 7j"'J 7J-B-% ~~-o}
A1 i'i~ ~~~ 1l.:<11~g A1~~-o}~c}. loJ1-c ~llR"'PJ .<i1Jti %JI} -¥-~i§~ llR-8-~)(J (aborted omphalocele), ~~q~.f
r (Homer's syndrome), {lllJ%zq~~ %% %\1~ ~q-s
Ai -B-"'J i§ ~ ~ ~ 01 <3"Jtr-.2..s--¥-£1 '?J= &m~ 01 s- ~ 7R -o}O:j Ai
<3"Jtr- g ~ -o}O:j GIA stapler~ 01 %""R Ai %*tl -¥--If:-~1 ~ zq
~7~~ (septotomy)% A1~~-o}~c} (.::1'83). loJ1011 Ai-c :§j)(J
~ {} -¥-1l-¥-£1 :;i rH )(J011 ~."'9 -B-"'J i§ ~ AJ~*% 0 1 ~ ~ 5'1
s;J,-c I 11 37R~ AJA19i- -o};z1~ 7};z1Jl ~)~ lHl-tl ~~ ~J%
01 (tripagus tribrachius conjoined twinsls-Ai s]1<5Ji'} 47~1\]
~ %-'f- ~ Jl~, *~ ~~01 ~}s;J,.2..uj 711rH-¥-£1 "'J)(J{}~
%~ 71A1-¥-lJ}A1 congenital band~ 7};z1Jl ~}s;J,q. ~\1~.2..
-o}O:j 01 %ll]011 Ai-c ~01-o}J11s:. ~ ~~01 01~ 7J{}~-lf:-~
(dual mesenteric supply) i§El1s- ~:<R-o}~.2..uj §VJ -¥-1l-c
34cm 011 ~ ~ ~ ~ ~1 1l. :<11 ~ g, rH AJ -¥-1l-c ~1l-¥--¥-£1 1l. :<11
~g A1~~""R Y.7}q7} -%l1l-¥- ~\17J LB~ ~~-& Aj"'J rH)(J
JI} %~5'10-1 ~}O-1Ai ~zq ~7~~% A1~~-o}~J,Jl 01~} %A1011
%\1 71 i§ ~1 ~ 1l. ~ .ULAj ~~s:. ~~-o}~J, q (.::1 '84l.
<3"Jtr- 3j)(J -¥-1l ~ 3 oJ1-c .2. -'f- 0 1 ~ <3"Jtr- % ~ ~1 i§ ~ 01
"'J% ~~Jl .::1 ~ 1 oJ1011 Ai-c ~):l17} ~}s;J,.2..uj, ~ ~ ~u
llJ~.2..s- sinogramg A1~~-o}O:j :7-FJi'} 'i:!~01 ~-c -B-i§~1
13
Fig. 5. Anorectal duplication: A, gross finding. The duplication is located just behind the normal anus; B, the sinogram, showing non-communicating tubular structure running parallel to the rectum.
Table 4. Associated Anomalies
Skeletal deformity
Cardiac anomaly
Conjoined twins
Imperforated anus
Cloacal exstrophy
Ileal stenosis
Diaphragmatic hernia
Omphalocele major
Meckel's diverticulum
Wilms' tumor
Intestinal malrotation
Polysplenia
Congenital band
Horner's syndrome
Left sided gallbladder
Number
3 2
T3:%g ~'il"6}~q (~~5). 301] .2.-'f- ;A2~~21 .f~-'2-s.
C>.J' 3 cm :Qo]s. Cl{~ JI~ (blind loop) ~El1s.A1 ~7B"6}~
-'2-uj, 72 AJ AJ-tl-21 ~~] 'ict 0] ~~21 ~71]~ ~% A]i5~"6}~
q. 101] O1JA1 ~ ~-i'f zj 11] 0 VJo] ~ 7B "6}~J q.
~~1] ~01] 701] (35%)01]A1 ojcl *~~] %~7]~0] ~7B6}
~JI Of 4) loj]01JAl~ oHH:J J,(JA~O}~JJI, 27B 0VJ21 7]~
0] ~~-8 7c-H-~ 701] ~01] 401]~L}. 111-¥--lt-~] 7cl-'f-~ W~
~o] ~A~"6}A] i'H);A]~ llHf~7JJI} ~zjCl{ t1]~L10}7} ZfZf
%~-8 201]01]A1~ ~ .f ~-g-¥-~-'2-s. A}UJ"6}~JI, 201]01JAl
2=c. ¢ "5" lT67-].A~ A].'~]A~OS. 711 <{].$W"" 111~<4 ~]li.~ A]i5~ 1.- -2 I rdO..!.t1 1- n 1---l"L.:. 1 ...... 1
~-& .f ~AJ ~:;c!g ~oj sq-'t:l"6}~Jq. 401]01]A1~ %~7]~
ulHH] ~-i'f zj 11]!it .B..s. A~ "'111] 0] AJO] 7B ~ Aj -'2-s. ~ A~ "6}oj
AJ ~*~-& 1733\1 Calder! 01] ~] tB ~ ~ <{i~JI 5'1 ~ JI
1884\1 Fiti7} li~\l"~] ~lA%o]c}JI A~ZfS=]01A]~ ~g
"duplication" -'2-s. RA}~ 0] .f01] oj cl rg ~ -'2-s. 7] ~ s=jli.i
~% 1937\101] Ladd4 %01] 21 tB qg JI} ~-& 37}A] .B..<:l%
%~ +,7] ~ ~ ~Fj 7] ~ 01] 111 "6}oj "duplication of alimentary
tract"o]~ %017} .5:.~s=j~q.
1. ~ ~~-8 :sra:~h=~·%o] ~J 01 oj: "6} JI
2. AJ-tl-21 01:':::::. -¥--It-JL} *A}~ AJIL1%O] ~7B"6}ojoj: "6}uj
3 rllB B 0 71A]. 7]'j!}JL161 7irJ.5:. '6}.J;l...Jll-01]A~ ~JI~ -¥-• '-1l T""'iI::""L 0 0 0 L..:. r --"1 --, '-' I L:. I l.!... '[
~o] ~J01oj: ~L}.
19521-,1 Gross !it Holcomb5 -& -'t1~1, ~El1, ~A~'§:j-<4 ~}o]
~ 01] -tl-11] 'ict 0] oj cl rg ~ -'2-s. RA} s=jli.i 0] 7] ~ 01] 111 tB
"dupliaction"o]c}~ %01~ 71]'{!9!Lr:}.
DB 4,50001]~] -¥-7,:l '8- 101] 72.5:.7} ~~-8L}JI ~C1A1 ~JJI
:;c!Al] 11] <4 'il ~JI O1JA1.5:. 96~lA01] A1 101 01] (1\101] 2.601D~ ~
JI~ ~T7} 71]~ fio] ~JI-8 7cl-'f-o]JI6, .;;-t1101]Al~ 1971\1
~ ~Pj]7} ~IE-8 0].fs.2 :;c!~1]<4-'2-S. C>.J' 4001] 72.5:. ~o] lJl..
JI-8 AJEl10]q. 111-¥--lt-21 lJl..JI01]A1 \:to}7} 3:-5- "C1 3i-~ ~
.5:.~ lJl..o]uj 7}~i2j-& 'ictJI %A] ~*~(synchronous
duplication)21 ~.5:.~ 15 %7J}A] lJl..JIS=] ~-'2-q 111-¥--lt- 5-10
%72.5:.21 ~.5:.s. lJl..JIS=]JI ~J L}!. ~ ~ -=-f01] A1.5:. \:to} (60 %)
O1JA1 ojo} (40%)lJl..q q~ 3i--& ~.5:.~ lJl..~J-'2-uj 101] (5%)
01]A1 ~AJ21 2r[1] 01] ~~o] ~]~]"6}~~[11, ~~o] ~~S=]li'!
~.l1l"6}A] i'J"-& (noncontiguous) o]cl~ %).] ~*~01] 111~ 7}
14
t-Aj-g- ~![-011 !J-J7- Ll-c- ~J-~.21 T.Ql:Q-f_- :gfCj ~~} ~iLt}ll
2Lc ~-c6-~*~-l ~A~$}~l~ -'tlZ1% ljDdii]-,c ~{l~ 7}
}.ri,~ O}0~ l@~j-S-}Alc f~Al~ Cl-.f;-ji} -~-'-?-=- ~7l-71 0H~-t:-0l
All AI 0'1 91 Cf. Bremer' (1944),c clA~71 5::§}'tlc ~d A,j:i'IAaoll~i
*~l,:m 'If'tlc'/,'-'[l't (vacuolization)"il 9Itl'lf%*~01 "!l{l
r+~- "aberrant luminal recanalization theory"* T~il}~~
ell 01 'c [Ii'''d' 9] 'll'ii'''t'i5' 91 ~i ~ "il [II -ol"i 71'll ~J ~I ';-%
ccl91tf. Bentrey<l} Smith' 096011": ~ 'i5',';-~91 11 AI~I'}!
(initial point) O_'i_ "split notochord tlleory"'~ 'T'll-ol'll,c 111
o H~ ~l-fr¥l ~ ~ ~*'-l -f-} (neuroenteric canalHl .21"0] :3:j0-f
~-l ~~ol <Q~l--t 01~3-1c~, T-l:lr~~~*, {J7d~-TI1--J, ~F6-~
-{;- %°1 ~"!l1h:lc1l0Iel. Lewis "I 1'hvng" (EX)S),Oc 111'&
71 5::§}'tlc91 111 tl 01 z)~tloj '-2+':.'6''£ 'lcLo_z!el,c
"diverticula theory" §- 'I- 'lfBI'll 'c ell 0] 7Fil ,"- "J--;>*o] :gc "0] ~l-),~t}~- ~-~}~ uJ-6J lI!.tl~==- Jl1<:i 0 l yi;l~ ~7,}~ ~lrH
"d"J"i1 -;''A-0171 nJ¥-"i1 "I~-oI~1 ~'il'11AI *-01-"- 'l!el. Bishop:Oj- Koop10 (]!J64)l" ElIA~.Vi91 W,I-0lef Al~5::~"i1
~-l"OB ~F6-~:g.0l A~{}L}jl fi}~Cl-.
p}Al~-~_~ '~~-*~"-°1 ~'{l~~ N-Jfllf§J.j91 ~2l-T!H~
partial twining theoDTll~ .<il~llf--:§l ~-J!l- [11~-~1 {l-,~-Bd C6-~
06'-011 ~ ~-§-5=H-=- °1-~~~ o1>!-P-=- ~"-~ 1{}12f ~lBl:lJ-BJ011
~1.'<ltl"i 0lcl~ "d r191 cy 'i5',,:.'6' 01 }1~J:01 ~O& A~Allll 71
f§-~ ~fil §1fl-11-l:j-~ ~011Ai ~tJ11- 0l~~~ J.~zl-~c]-. n] -:1- ij,JElBjJ.j (caudal twiningjo] V~- ~~91 ~,,';-~~- Al]91
-01-"- "split notochord theory"71'1N77I"1 71'll ';-%O'I'c 01
E-°ltf. ~-~~:g.i?:- T1J-01jl'i TIJ,~'7J]-,A] ~ r~ 01] AiL} ~A~~ -T- 9]
;zl~ :J. ~P]"il n14 3.JiI -lH'-. ~I {J°I;zI"J-, J':"J-, [I AJ- ~
{I-')}'1l".~ L]ii-lc 'l!e]. zl zl 21 '11~]"} L~1'I91 eel/I, o]Sc'j
:-E ~1 (gastric mucosa or pancreatic tissue)9-] -e~n -Itll-, BB -y--&~ ~-f§ (cystic or tubular G'lJC)-'6-01] u:]-~1- cl-°Jvl- ~ lJ ~"c}~- L-tEl-l--J!tl
'i5'AJ-2] '!l-'li-:'c Iverl2 (1995)'%,"i1 2]-01\'1 A~ '9' [..<11 01 LII
011 ~l<i'! 'Il" '115:.71 67 %011 0 I ~tf Jl t}1": [11 1', ,'h'-"il "15:.
75%0i1~i 1"11 pl~fOiIAi :;:l\1sl91ef. *-'1'- -{;-"'14.g. _J;J-~ i" "Ill 7nJ "II 1[14 ;1 H' 'lJ-~lt}6j :9_.::I.;I'-i!h} °F;l t}/N
:g.,~-o] ai~ 73q-~ \l~ %If-- {l-OClAJ- q-~81 ~{!S;]7]!T_ fi]
ui J ~-t011 6J~ ;E°d{2-lJ 6J~91 9-]-Y-1fl:lr5-:~-~ ~1-91S-1-/1
Y- %l,J~71"6d-£ ~01 ~~tl-71 ~lBB).i~ i-lf- {!'~J-~l- 1(t~ll-
-If-~J-~-*~Ol ;U~~ ~l-A}91 1/:1011).1 _*~J_ %,*~"-°1 §t{}¥l
rl-~ ~j17} 9],~ ~l!T_c6-~:g.o] 9J~ ,7clq- T-!2-]Yi?:- ~-¥- 7~
~lol ,,1 Jl.B}uj, 0] 'iJ-9-"iI'c .l\--Y- 3'c.(:-Cfr '\JA}71 ~-ol 91"1 9]~ ,~]A]-olr:j-.
~~)~ %-£.~~3f~J)-t %).l-~ ~AJ~- 1--tEl-1-R71~ tl-o:1 "c}1f
~l~-~- s:OCl-~jJl- ~-1 .1:-{;-:Jl-{t ~-i51] ,1:l\l~ ~::: 9],r]-. ~-1
]tJl13.lG 011Ai ~l'!tJ)-t _llL%o] 9]~- ~J;-~Q] ~-9-~- ~~"';-0~<?J
~n~-~, ~J-q-, 1do]A]~- i~]j:n %0] -& 4-!T_ 9],rl-jl il]-~J._Jl 0]
111'-- Q:jii]J.j ~~1\J--{-} X=-~-?-?"Ql ~1u-~ l}Al-§ !J.y_t}S1q.
zl "11 21 47-63 %!!}A] ;%1 "l<!iTIc -'Lim 'l!".uj .:0- 'l'i'r-Oil"l
_'C 5::CYolI"i 67% (Will, 01 'i5' l'1'2-°Il}'i'i'l ':57% 02 "i1J 91 ~l£-s- Jl.~c]-. C6'-AJ,~ ~o.~ -?-Ti, ~~- Ji~'i!- -'6-91 '12jP~ c6'AH· L-IE},-~1": '1J-9-71 ~tloj ,~-!f- -<\,,"171 'iiAj"1715:. t}oj
Z!<~- ~- ~~~% ~~7]-C leading points_ A}%-6}7]S=_ ~
r}. ~E~ 0] ~-1;{1~- o]i:)~ !f-n-l~-ol ~~,;{ltl-~~ ~1~71- ~01-
1l\'!% !;l,0171_'C. '01"1 Iloyle "llloing17 09821.g. -'i'l1l uf r~
{L-011 -T~l°,}-~ ~~7'1 i,~91 ~-l-t-°l A]<l 111'--~- !J.y_t}~q.
01 7H· Technetium-99m scintigraphy71 z)\1"i 71~171
~A1'i!- !f-j-£Jj ;~Y}7} ~1~1- T 9],~ A1111-~~s;. A1-_§-~l:]-tl.
c<l 4= J?1,l~.l9 -"- 1:11 ul *' H1-"- ~ 0171 c ~l n1 ~f 0= 01 '-. I.--fl 0 0-] '---- ,_ , B '_2.':L _L- 0r~1 oTT, ° 0J~s;. _9_~q 2il;].£ B}L--]- 9J_-Y-01]Ai~ ¥%AJ-~~ J.j910] tl
1~1}AI ;zILI715:. tloj ,';-!f- 3'%.iiIl" [JAJ- 'i5'~-oIJAl JLS'. }~
"H 71':l21 -li-'il fri'-~ "'1'1l-oI'cell 2]nl'l!'c 7,lA}0Irl.
~:-~ ~-1;{1011 ~l-A~~lf"l S'.~ ~~,,';-~011 rH~ /8~~ ~,~
~\li?:- ~L9q-n:j ~\l'~1 7H~~0]L} *~71BJQ-] .lJ!.,Aj% ~1~
Tfe"iIAl -9-'i'!-oi ¥J::cI"Hc 11-9-;1 ~iq. "I~ QJl_2II "i1 -"It}
\'l ~"' ±-g-TII 7~A}0iIAi 50%'71"1 'll:;;:!~ !;l,j171 n-"-"1 ~~~7J-lB L-d-J.j *$17} ~l:d :;<lB-~ ~-9--21011 AJ ~~*06'-% ~
~ ~-B- 9-1 ~ -tl- -2-lJ% ~ ~ ~ ~::: 9J 0-] AJ lJ ~-B-j1} .<f} 11] ~
'i'l~. 'i'! 71Itloj°F ~tfl1 !-J5:.'i5'~-~91 'li!f-oIIAl '1l'i'l9i 'i'!711 7} ~1_t,:. ~B:zl~% _Rfi]-711..-t i~-A (11~-!2-1 ,j -tlJd-Bd c6-~:g.
91 111'-- JIJ¥l~-l~} :::iA1]l} ~--f_-%J.} ~"--=9--~]~- (short bo\vel
syndrome)% '"?J9_~ -T- 9],~ /.d-~J-01jl'i-.i=- llAlLt;Lrl-~ ~~~'~1
91 ~12.t ~/+~ (mucosal stripping) 0] #%11- ~H~ ql~lo]cf2.
°lcl~ ~.Al~ 1%2cJ Wrenn'loil !'Pl "1% .'C'lJ.5'I91,cL11 "il\'l'l11i "H~;(l]§- jIlWtlAl O]7,-Aj 'll"l-.:l:- '';'-AI''i1 "il/l
BH~ JLill7} ~l~~ z1]71¥l °l~Aj 1J~--?- zB A] ll7;] ?J-9lt:}.
1JO]A]~- 06-~, !f-S-] :f'1]~-% ~~c)1-7-]Lj- ~H:J: '-~~101] ~t,:I!O]
9l~ ~~~C {l°17]AJ~~9~ 3'::[~~0- (marslipialization)0] cl .g- ~].fOL 1l 0 1 C}ll,~-J.
J -2-] lR tJn9~{2-0] 6]o~~ T 5:1,~L]- o]~ o]s:/'a -i'-]~~t
0] ~f ;-)f)%JJ}A] ~.g- ~~s. 1:;:11il}7] u:]1-R-01] ~.g- ~~,g-
0}L-]C-}:'2. ~-AJ ~s}2:i,267} Ad~9-] ~- "6-~%01]J'1 ~.:~-11] Jil_-=tL
ccl?Lccl-} ':::0IQI ;;J-'i-;C- OJA,j 'lI'I1°171 TIiI~"i1 ~nj~ ~6J
.g. ~"}QI *"d "illl"} "B'l£ "d·"I"i1 1'lJl_~ :2>'1 °1"dO_y_
.c);l~Ol-AH-~ ?J-o}oF ~}l:t £l.c01H-~ ~+8 i:%l!}9-} ~~ i:
-g-.IT}-~ ~iiloj J'PNI i'.i!17} :;-) \1'tl'il.j'-oJl ~iiloj \apamscopic-assistcxl surgery (U\Sl~ APHI 91-;; l!.2'L ~cl27_
_li~ f~.g- 7J-?-ol] ~~nQ-] ~j: 1/37J})(j %V}7]Sj,g- 7}~C}Jl
'll"IAl ~;cril -C' '?iJL"iIAl'L 35% (7"11)91 -6'-1)1: !I'il%-;lc !;lSLccPj 2j~ 0IAJQI %~171"H- 71:;-) l,l-'i-.'C. 20 % l4'>lIll-} ~19ic-}. *-l:l,~t~%-3- 0l~- ~~, :li?r- %~- lJ-e (vertebral
fusion defect) -'o~Ql ~PF 7]~-g- %~lt}7]~ ~t--V< ~~Ql ~
.tt*.g. AJ i91iH (intesinal atresial% -'i-l'}ii}71'T_ iil.el'l 01 ;C- Bishop :of KOOpll1 (1964)01 lIIAH} filA~cE!IQI 91'J°I L t AFJ~*01] 9-]oll ~-c6-~*ol A~:ur},c Z}7d01 iL~% /d-s:~ °l-::'-"il i:'-/17} Bll c~;<J.i!t "~'ifQi 'i'Hl "H;-J'hs,2K,"- oH;-
_~L-]o} %it} -6-1{}-~ ~~ 5:1,1:]-. xvl- 01* ~~ ~-f110}
(heteropagus conjoined twins)11 %~lfl .lC2.'C. 91r:j-G 01* % tfl- 71f@~-3- ~_l:l, 3"":-£-l'l, l,:}-1f- ~lAJ-:rl- S:~-~, [l]AJ- :t:~<f
~d-~- ~t}O:j ~H01] ~-g--g: ~~. T 9l t l fl:- ZhL01]J,i~- ~~
~ 71BcJ% A~]91~ C4?-l Bjll~-] *~ 716j~% {!~~ T- 9J (dtl
'if-3*'6',"- cB-H'- 1-"11 "1'i!Qi -1to}"iiAl '!fBocIL9 "I 'if W~l~7} ~lfr ¥~-]~Ji cH1f-\f:- l'-"d-'6d_O_~ ,eAl1t}A1~ .f:~
011 -i'-]~111- ~~~ ~:o.~ J-j;gt32-~ ~A~11-Cl-. :;z11;[l-3i 7B~~ AJ -'i-<;:!iil :;-)\hl;C- l,l-'f-7I ~tlAI'i'! 'c~ \'l¥l:0171 TIiI~-"i1
01 ~tf"il 1:Jm ;<J~l'11 .AI~I% 7}AI:il AJ"J"i1 lqA 7}7J "1 -TI~ ~~-g- t~t}~- ~o] %_~t}q.
'llJ;J*-"d% '-IEllil.e lO,BJol '-101. 'll\'!QI -'110\1, '1J\,!QI "O~~J."Q:}:±j %~2J-011 rrJ-t'-} t=}°JB}J] T~R-011 ~-~ ~lq--f_- 4l&:· <Qo1 o}L-]A]17l ~lf- ~*:rr} 7riA},c ~7d-ln ~jl].~ ~~c)l-jl
15
lCl-E {1-1P1QI {l-\'! ';l §,,"/I'ilQI ¥Hci"il °l~w -T 'iN :r~~ ::ZlAl-%Ol 7d'~~ *~]9-1 1f~.g- 7d--9-01jJ·i:,:. ~~~~711, _R
'"'- A~6JlIl, lCl,c~ ~:ili1QI mhl !I'il-;lc §'ll1!71 ITiI{HI ~ ~~Q-] ~].fOL ~~-~ O]-L-]2-} %vl 7] Sj 9_] ;;zi1i~ j17.>:j ~Ai
% 8]8}c ~ xvl- -'3~iL11- ~olcl-.
1. Bond SJ, Groff DB: Gastrointestinal Duplications, in
O'Neill JA Jr, Rowe MI, Grosfeld JL, fonkalsrud EW,
Coran AG(eds): Pediatric Surgcl)\ed 5), chap 83. St.
Louis, Mosby-Year Book, 1998, Pp1257-1267
2. ~-%TI-, -i'-All-%, i?~~ol-: ~/-F-¥~ 2ot!li:Jl. rll~1-91:;:il'~--f
"171 13:456-9, 1971
3. FiLz RH: Persistent umphalumesenteric remains: Jheir
importance in the causation of" intestinal duplication,
cyst formation and obstruction. Am J Mcd Sci
88:30-57, 1884
4. Ladd WE: Duplications of the alimentary tract, South
Med J 30:363, 1937
5. Gross RE, Holcomb GW .II', Farber S: Duplications of
alimentary tract. Pediatrics 9:449-468, 1952
6. Holcomb GW III, Gheissari A, O'Neill JA: Surgical
management of alimentar,}' tract duplications. Ann Surg
209:167-174, 1989
7. Bremer JL. Diverticula and duplications of the intestinal
tract. Arch Pathol 38: 132-140, 1944
8. Bentley JfR, Smith JR: Developmental posterior enteric
remnants and spinal malfhrmations: The split notochord
syndrome. Arch Dis Child 35:76-86, 1960
9. Lewis FT, Thyng FW: The regular occurrence of intes
tinal diverticula in embr}'os of the pig, rabbit and man.
Am J Ana! 7:505-519, 1908
10. Bishop He, Koop CE: Surgical management (~l duplica
tions of the alimentary tract. Am .I Surg 107:434, 1964
11. Wrenn EL Jr.: TM: Alimentary Tract Duplications. in
Ashcraft KW, Holder TM(eds): Pediatric Surgery(ed 3),
chap 36. philadelphia PA, \VB Saunders, 1993, Pp
445-456
12. Iyer CP, Mahour GH: Duplications of alimentary tract
in infant and children. J Pediatr Surg 30(9):1267-1270,
1995
13. Grosfeld JL, Boles ET Jr, Reiner C: Duplication qf
pylorus in the new horn-a rare cause of gastric outlet
obstruction. J Pediatr Surg 5:365, 1970
14. Ramsey GS: Enterogenous Lyst of the stomach simula
ting h)pertrophic pyloric stenosis. Br J Surg 44:632,
16
1957
15. Stringer MD, Spitz L, Abel R, Kely E, Drake DP,
Agrawal M, Stark Y, Brereton RJ: i\4anagemenl of ali
mentar}/ tract duplication in children. Br J Surg 82:
74-78, 1995
16. Lavine lE, Harrison M, Heyman MB: Gastrointestinal
duplications causing relapsing pancreatitis in children.
Gastroenterology 97: 1556-1558, 1989
17. Royle SG, Doing eM: Perforation of the jejunim secon
dm)) to a duplication C)/st lined vFith ectopic gastric
mucosa. J Pediatr Surg 17:563-566, 1982
18. La Quaglia MP, Feins N, Rraklis A, Ilendren WI i: Rec
tat duplications. J Pediatr Surg 25:980, 1990
19. Kangarloo H, Sample \VF, Hansen G, Robinson JS,
Sarti D: Ultrasonic evaluation of ahdominal gastroin
testinal tract duplication in children. Radiology 131: 191,
1979
20. Schalamon J, Schled' J, Hollwarth JvIE: Ecperience -.,vith
gastro-intestinal duplications in childhood. Langenbecks
Arch Surg 385(6):402-405, 2000
21. Dlmcan BW, Adzick NS, Eraklis A: Retroperitoneal ali
mentary tract duplications detected in utero. J Pediatr
Surg 27(9):1231-1233, 1992
22. Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, Mc
gowan MA, Martin LW: Duplicalions of alimentary lracl.
Clinical characteristics, preferred treatment. and associated
n1a(jimnations. Ann Surg 208(2): 184-189, 1988
23. Wrenn EL: Tubular duplication oj' the small intestine.
Surgery 52:494-498, 1962
24. Gardner CE Jr, Hart D: Enterogenolls cysts of the duo
denum. JAMA 104:1809, 1935
25. Hickey FW, Corson 1M: Squamous cell carcinoma ari
sing in a duplication of the colon. Cancer 47:602-609,
1981
26. Orr MM, Edwards AJ: lvTeoplastic change in duplications
oj'the alimentary tract. Br J Surg 62:269-274, 1975
27. Schleef .I, Schalamon .I: The role oj'laparoscopy in the
diagnosis and treatment of intestinal duplication in chil
dhood. Surg Endose 14(9):865, 2000
28. Bower RJ, Sieber \VK, Kiesewetter \VB: Alimentary
tract duplications in children. Ann Surg 188:669-674,
1978