Alimentary tract duplications in newborns and children: Diagnostic aspects and the role of laparoscopic treatment

Alimentary tract duplications are rare congenital lesions normally diagnosed in newborns and children that can occur anywhere from the mouth to the anus and have a reported incidence of approximately 1 in 4500 life births. Symptoms and clinical presentation vary greatly. The presentation varies according to age and location. The treatment finally is surgical; total resection when possible should be the aim of the intervention. In pediatric surgery minimally invasive surgical procedures became more and more important over the last decades. In consequence the operative procedure on alimentary tract duplications changed in this manner. We review on case reports and clinical reports on minimally invasive surgery in the treatment of alimentary tract duplications, determine the importance of minimally invasive techniques in the treatment of this rare entity and rule out that further studies in the field should be performed.

Alimentary tract duplications in infancy and childhood. A 25-year experience with focus on rare types of the disease

Background: Alimentary tract duplications (ATDs) are rare congenital anomalies of the gut tube, seen mainly in neonates and infants. Their presentations are often mimicking other conditions, thus posing a diagnostic challenge. Surgical treatment is required in all cases. Objective: The aim of this study is to present our experience in the diagnosis and management of this condition. Subjects and Method: We, retrospectively, reviewed 7 duplications in 7 patients and analyzed sex, age, clinical presentation, location, complications, diagnostic work-up, surgical methods and post-operative course. Encountered diagnostic and surgical difficulties were also reviewed in two extremely rare cases. Results: Patients’ age varied between 2 months and 10 years. All duplications were single. Six of them were intra-abdominal and one thoracoabdominal Three ADTs were asymptomatic and discovered during routine X-ray imaging. One ADT involving the cecum was mimicking appendicitis and complicated by recurrent intussusceptions. The thoracoabdominal one proved a surgical challenge as it was a completely isolated ATD. All patients underwent surgery without postoperative complications. We conclude that despite their rarity, ATDs require a high level of clinical suspicion, especially if they are presented as thoracic masses. Appropriate diagnostic investigation of the pediatric patients is always necessary to avoid delay in diagnosis.

Metabolism of carbohydrate in alimentary tract of reindeer in winter

The study was conducted on six reindeers in December.It was established that concentration of reducing sugars in the chyme of jejunum increases substantially(6 times in comparison with abomasum),whereas concentration cellulose,on the contrary,decreases(4.5 times).The maximal increase of monosaccharides in the small intestine testifies to formation of metabolic fund of sugars in this part of the alimentary tract due to high degree of polysaccharides hydrolysis of exogenous,as well as endogenous,microbial formation.Obtained data assume that the need of the reindeer for glucose is provided for not only by gluconeogenesis as it was considered before,but also by absorption of monosaccharides from the alimentary tract.

Enteric duplication cyst as a leading point for ileoileal intussusception in an adult:A rare cause of complete small intestinal obstruction

Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.

Studies on sedimentary events in Mariana Trough and characteristics of geomagnetic field change

The analysis on the magnetic fabric of profile of the sedimentary core taken in five stations in the small spreading ridge area in Mariana Trough shows that the effect of indicating its depositional fabric, sedimentary rhythm.sedimentary events, sedimentary interfaces and sediment composition as well as sedimentary dynamic environment by magnetic. Parameters is clearer than that by traditional method of analysis. The indication of sedimentary events can show its high resolution. The study on the Late Quaternary sedimentary events in this area shows that this area underwent four big events of sudden change in the Holocene epoch based on the sudden change of underflow direction and the position relationship between ash beds and erosion sediment layers. The sudden change of underflow direction is a believable evidence for judgement and study of sudden event within this area. The direction changes of its geomagnetic field show three morphotypes i. e. relatively stable type and non-stable type of oscillatory amplitude of magnetic inclination (Inc) which existed during the relatively stable period of amplitude of magnetic declination (Dnc). Anothertype is characterized by big amplitude of both inclination and declination.The space-time series of the three type mentioned above is a new way for forming a high-resolution stratigraphical timetable.

Thoracoabdominal duplication with hematochezia as an onset symptom in a baby:A case report

BACKGROUND Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract,whereas thoracoabdominal duplications only account for approximately 2%of all alimentary tract duplication cases.Many symptoms,including abdominal pain,abdominal distension,vomiting,gastrointestinal bleeding,chest discomfort,chest pain,and shortness of breath,may be present in patients with abdominal or thoracic duplication.CASE SUMMARY A 10-mo-old infant,with a free previous medical history,was admitted to our hospital with melena three times in 6 d.Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities,spina bifida,meningomyelocele towards the posterior mediastinum,and possible concurrent infection.Upper gastroenterography indicated intestinal malrotation.A laparoscopic abdominal examination was performed,and the operation was intraoperatively converted to laparotomy.This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication.The intestinal duplications in the abdomen and large part of the thorax were excised.The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa.The infant recovered well and was discharged 1 wk after the surgery.A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced.CONCLUSION Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.

Gastrointestinal bleeding caused by syphilis: A case report

BACKGROUND Syphilis is a chronic,classic sexually transmitted disease caused by Treponema pallidum,which can invade almost all organs of the body and produce various symptoms and signs.Although there are some cases of colorectal bleeding caused by syphilis,small intestinal bleeding caused by syphilis is still rare.CASE SUMMARY A 58-year-old man had experienced recurrent abdominal pain and melena for 3 years.Repeated gastroenteroscopy and computed tomography angiography examinations failed to find bleeding lesions.During the same admission,multiple intestinal ulcers were found by capsule endoscopy,and syphilis was also diagnosed.With a history of atrial fibrillation and chronic pancreatitis,he had undergone mitral valve replacement and tricuspid valvuloplasty for valvular heart disease.After anti-syphilis treatment,the melena and abdominal pain disappeared and his hemoglobin gradually increased.It is considered that gastrointestinal bleeding,chronic pancreatitis,atrial fibrillation,and heart valvular disease may have been caused by syphilis.CONCLUSION This case report found that syphilis can mimic systemic disease and cause intestinal bleeding.In addition,treatment of the disease requires both sexual partners to be treated.Finally,although syphilis is easy to treat,it is more important to consider that bleeding could be caused by syphilis.

Colo-renal fistula:An unusual cause of hematochezia

A 76 year old woman with bloody stools and symp-tomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell car-cinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.