Martin Stenzel (Institut für Radiologie/Unfallkrankenhaus Berlin-Marzahn/Deutschland)  

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5 Months  

Male  

GI-Small intestine  

congenital  

5 month old male infant. Acute vomiting several times a day since the second month of life. Physical examination is unremarkable.  

A duplication can occur from the mouth to the anal canal, always in relation to the gastrointestinal tract. Mucosa with secretory glands lead to cystic and tubular appearance.  

<- view Ultrasound 1

Ultrasound 1: B mode [Toshiba Aplio 50]:
5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




<- view Ultrasound 2

Ultrasound 2: Color coded ultrasound:
In the color coded US there is evidence of vessels.




<- view Ultrasound 3

Ultrasound 3: B mode:
5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




<- view Pathology 1

Pathology 1: Intraoperative/macro-/microscopic findings:
Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
[With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




<- view Pathology 2

Pathology 2: Intraoperative/macro-/microscopic findings:
Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
Macroscopic sample, opened: a mucocele is marked with an arrow.
[With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]

 

Surgery / Histo  

Mesenterial cyst, Omental cyst, Meckel's diverticulum  

According to IYER 2/3 of the cases become clinical within the first year of life. The symptoms are dependent on the location of the duplication. Duplications may represent origins for intussusceptions. Further complications: hemorrhage, perforation, ileus.
Multiple isolated duplications have been also described in one child (MENON).
According to IYER duplications are associated with cardiac anomalie, myelomeningoceles and microcephalus.
Etiology: vascular insufficiency which leads to separation of small bowel segments in the fetal period?
Noncommunicating duplications are extremely rare (so far only 4 case reports). As in the case of STEINER there seems to be a resorption of the secreted fluids in the noncommunicating variant.  

The duplication was shown on a prior study (not shown) as a cystic structure with a luminal width of 30 mm.  

N/A  

1. Medline:
Iyer CP, Mahour GH.
Duplications of the Alimentary Tract in Infants and Children.
J Pediatr Surg 1995; 30:1267-70.

2. Medline:
Steiner Z, Mogilner J.
A Rare Case of Completely Isolated Duplication Cyst of the Alimentary Tract.
J Pediatr Surg 1999; 34:1284-6.

3. Medline:
Menon P, Rao KLN, Vaiphei K.
Isolated Enteric Duplication Cysts.
J Pediatr Surg 2004;39:E27.  

infant, acute vomiting, acute emesis, intestinal duplication, cyst, surgery, noncommunicating duplication, small bowel duplication, duplication, noncommunicating, child, childhood, pediatric radiology  

Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
URL: www.PedRad.info/?search=20070112213053