Intestinal duplications are tubular structures that are attached to the intestines and share a common blood supply; their lining resembles that of the gastrointestinal tract. Treatment is surgical resection.
(See also Overview of Congenital Gastrointestinal Anomalies.)
Duplications can be cystic or tubular depending on their length.
Intestinal duplications are uncommon, occurring in 1 in 4500 live births (1). Males appear to be more commonly affected. Approximately one-third of affected children have associated congenital anomalies of the gastrointestinal (GI) or urinary tract. Colonic duplication is often associated with anomalies of the urogenital system. Vertebral defects are also common.
The etiology of intestinal duplications is unknown. Theories include abnormalities in recanalization, vascular insult, persistence of embryonic diverticula, and partial twinning. The lining of these duplications most commonly resembles the adjacent portion of the GI tract, but it can be heterotopic and contain gastric or pancreatic mucosa.
The most common site of duplication is the ileum followed by the esophagus, colon, stomach, jejunum, and duodenum (1). Intestinal duplications usually present in the first or second year of life.
Duplications may be detected prenatally by ultrasound, incidentally after birth, or once a child develops obstructive symptoms (eg, abdominal pain, vomiting, failure to pass stool, abdominal distention), chronic pain, GI bleeding, or abdominal mass (1, 2). Duplications in the chest can cause respiratory symptoms or feeding issues. Duplications containing heterotopic gastric or pancreatic mucosa can result in perforation.
General references
1. Sangüesa Nebot C, Llorens Salvador R, Carazo Palacios E, et al. Enteric duplication cysts in children: varied presentations, varied imaging findings. Insights Imaging. 2018;9(6):1097-1106. doi:10.1007/s13244-018-0660-z
2. Rattan KN, Bansal S, Dhamija A. Gastrointestinal duplication presenting as neonatal intestinal obstruction: An experience of 15 years at tertiary care centre. J Neonatal Surg. 2017;6(1):5. doi:10.21699/jns.v5i4.432
Treatment
Surgical resection
Treatment of symptomatic intestinal duplications is early surgical resection of the duplicated portion.
The need for and timing of surgery for asymptomatic duplications is less clear (1).
For proximal lesions, an endoscopic approach can be considered when a highly skilled endoscopist is available (2, 3).
Treatment references
1. Sangüesa Nebot C, Llorens Salvador R, Carazo Palacios E, et al. Enteric duplication cysts in children: varied presentations, varied imaging findings. Insights Imaging. 2018;9(6):1097-1106. doi:10.1007/s13244-018-0660-z
2. Özcan R, Hakalmaz AE, Emre Ş, et al. Endoscopic septum division of tubular esophageal duplication in two children and systematic review. Pediatr Surg Int. 2022;38(11):1525-1531. doi:10.1007/s00383-022-05205-z
3. Gjeorgjievski M, Manickam P, Ghaith G, Cappell MS. Safety and Efficacy of Endoscopic Therapy for Nonmalignant Duodenal Duplication Cysts: Case Report and Comprehensive Review of 28 Cases Reported in the Literature. Medicine (Baltimore). 2016;95(22):e3799. doi:10.1097/MD.0000000000003799
