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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Brandigi E., Molinaro F., Meucci D., Sica M., Bindi E., Messina M.
Division of Pediatric Surgery, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
Duplication of alimentary tract are uncommon congenital lesions that can occur anywhere from the mouth to the anus and have reported incidence of 1:25000 deliveries. The ileum appears to be the most common location and the majority duplications are cystic lesion. Symptoms vary with the location, the type and the complication like volvulus formation. Midgut volvulus is one of the most life-threatening abdominal emergencies in the neonatal period. It is necessary to be aware of this condition despite his rarity. We present two cases of acute abdomen in new born caused by volvolus secondary to ileal duplication cyst with a review of the literature. Patient 1: Male neonate, presenting at the birth cyanosis and progressive abdominal distension. The abdominal ultrasound showed free fluid within the peritoneal cavity and a only one dilated loop of bowel. On surgical exploration, large volume hemoperitoneum and a volvulus secondary to a mid ileum cystic duplication was found along the mesentery with gangrene of the involved segment. Local resection along with excision of 15 cm of involved bowel and end to end ileoileal anastomosis was done. The histopathology confirmed the diagnosis. Presently, the child is 8 years old and doing well. Patient 2: 48-hour-old infant female neonate present to us for abdominal distension and bilium vomiting. The abdominal radiographs revealed features of small intestinal obstruction. On surgical exploration, volvulus secondary to a terminal ileum cystic duplication was found along the mesentery with gangrene of the involved segment. Local resection along with excision of 16 cm of involved bowel and end to end ileoileal anastomosis was done. The histopathology confirmed the diagnosis. Presently, the child is 7 years old and doing well. The natural history of intraabdominal enteric duplication is quite variable ranging from causing complication that require surgery in the first day of life to being indefinitely asymptomatic. Volvolus is rare complication of enteric duplication and occurred near 23% of patient affected. We perfomed a review of the literature from 1957 to 2012 and found no more than 26 cases of volvulus secondary to jejunal-ileal duplication. All the cases (except 4 that occurred in patient older than 1 month) resulted in new born with the symptoms of acute abdomen.