1、Duplication of the alimentary tract,Huimin Jia Department of Pediatric Surgery,Duplication of the alimentary tract are rare spherical or tubular structures which can occur anywhere in the tract from mouth to anus. Some of the anomalies were also called “enterogenous cysts”.,Introduction,Embryology,T
2、he etiology of GI duplications has still not been established. Several theory about the occurrence of duplication:recanalization failure theorysplit notochord theoryabnormal blood supply theory,囊肿型,Pathology,管状型,Pathology,Pathology,Duplications are hollow structure that involve the side of the assoc
3、iated gastrointestinal (GI) tract. They tend to share a common muscular wall and blood supply with its mature bowel, although each has its own separate lining.,Duplications containing gastric mucosa are at risk of peptic ulceration, perforation and haemorrhage. Patches of ectopic gastric mucosa alon
4、g the GI tract may represent the mildest manifestation of duplication abnormalities. Ectopic pancreatic tissue has been reported in duplications of the stomach, ileum and colon.,Pathology,The contents of a duplication vary with the type of epithelial lining of the structure, the presence or absence
5、of a communication with the proximate part of the GI tract and the absence or necrosis of the duplication wall.,Pathology,Esophageal duplication,Gastric duplication,Clincal expression Less common, account for 3.8% of all GI duplication; 60% found in the 1st year of life, 40% appear in neonatal perio
6、d Palpaple cystic mass in the upper abdomen accompanied by vomiting and weight loss Rarely undergo peptic ulceration, haematesis and melaena Often difficult to make a preoperative diagnosis.,Barium meal: compression of the stomach, usually along the greater curvature, or a communication between the
7、stomach and the duplication Another cyst, esp. esophageal cyst may also exists.,Gastric duplication,Rare Vomiting, weight loss and a palpable abdominal mass are the main findings. X-ray findings: signs of gastric outlet or duodenal obstruction with a lack of distal bowel gas,Gastric duplication,Trea
8、tment: surgical excision of the duplication,Pyloric duplication,Duodenal duplication,5-6% of all duplications Often behind the duodenum and do not communicate with the bowel lumen Vomiting due to partial or complete duodenal obstruction, haematemesis, perforation Upper abdominal mass Barium meal sho
9、ws compression of the duodenum Ultrasonography shows cyst lesion below the liver,Treatment Excision of the duplication Cystoduodenostomy Stripping off the lining mucosa and leaving that part of the cyst which is adherent to the duodenum or pancerase,Duodenal duplication,Duplication of the small inte
10、stine,45% of all alimentary duplication Cysts at terminal ileum most common Always exist at the mesenteric side Clinical manifestation：obstruction,abodominal mass, haemorrhage ， peritonitis and others Pancreatic and gastric mucosa may present in tubular duplications, which can be found with Tc-99m i
11、sotope scanning.,腹腔内边界清楚的厚壁囊性肿物，圆形、椭圆形或不规则形，内呈无回声，与肠管关系密切。,囊肿型ATD：主要表现为腹腔囊性肿物,管状型ATD :腹腔内异常走向的不规则形囊肿,腹部CT 囊肿型ATD在CT上多表现为腹腔内与肠管关系密切的囊状、单房、厚壁的低密度肿物，大多边界清楚，圆形或椭圆形，管型重复畸形及少数囊肿型重复畸形囊性结构的形状可不规则。,增强扫描可见囊壁强化，但囊内容物无增强。若与正常肠道相通,囊肿内可出现气体影。,合并肠梗阻时伴肠管扩张,由于管状ATD走行迂曲,在不同层面上可显示2个甚至多个单房囊腔影的层面。,Treatment For cystic d
12、uplication: resection of the cyst with adjacent bowel For long tubular duplications:1. Coring out the mucosal lining of a long tubular duplication through multiple seromuscular incisions in the wall of the duplication2. anastomosing the distal end of the duplication to adjacent normal intestine, all
13、owing free drainage of the contents,Small bowel duplication,Colonic duplication,Rare 16-30% Constipation or obstruction Barium enema may demonstrate a communication or a compression Associated genitourinary and lumbosacralspine abnormalities should be noticed,Colonic duplication,Treatment:The pricip
14、le aim is to end up with two colons draining through one anal orifice,Rectal duplications,Presentation of the cysts depend on:a: size b: fistula c: infection d: ulceration e: malignancy,Rectal duplication,Treatment:surgical excisionA transanal or transcoccygeal approach can be employed,Meckels Diver
15、ticulum,The first known description of thisdisease was in 1598 by Hildanus.,Meckels Diverticulum,Results from failure of the proximal duct to obliterate Abnormal regression of the vitelline duct can be result in *cysts* fibrous bans linking the intestine to the abdominal wall * umbilical sinuses *complete persistence as an omphloileal fistular,Meckels Diverticulum,bleeding-most common obstruction inflammation perforation others,Meckels Diverticulum,difficult to diagnosis different operation,Diagnosis and Treatment,11th Floor of 2nd building,That is all, thanks!,
