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Reminder of important clinical lesson
CASE REPORT
Total midgut duplication: a ticking time bomb
  1. Vikram Khanna1,
  2. Kashish Khanna2,
  3. Maddur Srinivas2
  1. 1Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
  2. 2Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Kashish Khanna, kash.modern{at}gmail.com

Summary

A day-old neonate presented with bowel obstruction and an abdominal mass. Exploratory laparotomy revealed complete tubular midgut duplication from duodeno–jejunal junction up to terminal ileum which was communicating with the ileum distally. At the proximal end, another 5×5 cm duplication cyst was identified and excised. Postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3×3 cm foregut duplication cyst, but there were no respiratory symptoms. While being planned for an elective surgery, he presented at 6 months of age in emergency with massive bleed per-rectum and shock. He underwent Wrenn procedure without any injury to the normal bowel. The thoracic foregut duplication cyst was excised later. Total midgut duplication, though benign, may present with life-threatening haemorrhage if left untreated. Presence of one such lesion warrants a search for others. Mucosal stripping is a simple and safe alternate to resection.

  • paediatric surgery
  • gastrointestinal surgery
  • radiology
  • congenital disorders
  • paediatric intensive care

https://doi.org/10.1136/bcr-2017-223848

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    Footnotes

    • Contributors The child was admitted thrice under the care of MS. The child was managed collectively by MS, VK and KK. The manuscript was drafted by KK and VK. All authors were involved in the revision and approval of the final manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.