J. A. Sujka1, J. Sobrino1, L. A. Benedict1, H. Alemayehu1, S. St. Peter1, R. Hendrickson1 1Children’s Mercy Hospital,Kansas City, MO, USA
Introduction:
Enteric duplication is a rare congenital anomalies with varied clinical presentations that requires surgical resection for definitive treatment. Historically this has been approached with laparotomy for resection, but with the advent of laparoscopic techniques this is changing. The purpose of our study was to determine the patient demographic, natural history, operative interventions and outcomes of pediatric enteric duplication cysts in a contemporary cohort.
Methods:
With IRB approval a retrospective chart review of all patients less than 18 years old treated for enteric duplication between Jan 2006 and Aug 2016 was performed. Demographics, patient presentation, diagnostic testing, operative technique, intraoperative findings, hospital course, and follow up were evaluated. Descriptive statistical analysis was performed; all medians reported with interquartile range.
Results:
Thirty two patients underwent surgery for enteric duplication, with a median age of surgery of 7 months (IQR 2.5-64), 62% (n=20) were less than 1 year old. They had a median weight of 7.3kg (IQR 6-23). The most common patient presentations included prenatal diagnosis of 37% (n=12), abdominal pain 28% (n=9), and bilious emesis 15% (n=5). Thirty one patients had their cyst approached laparoscopically with only two requiring conversion to an open operation. Operative time was a median of 82 minutes (IQR 54-124) with 25 of 31 patients requiring bowel resection. The median length of bowel resected was 5cm (IQR 3.2-7).
The most common site of duplication were ileocecal (n=15, 46%), followed by, jejunum (n=6, 18%) and esophagus (n=5, 16%). Twenty two (68%) of the duplications had a common wall with the GI tract whereas only 11 (34%) had a luminal connection with the bowel. Postoperative median hospital length of stay was 3 days (IQR 2-4.5) and median number of days to regular diet was 3 (IQR 1.5-4). No patients required re-operation during their hospital stay with only a single surgical site infection was reported, with a median length of follow-up of 24 days (IQR 20-31).
Conclusion:
Currently most enteric duplication cysts are diagnosed prenatally. These can be managed laparoscopically with minimal short term, even in neonates and infants.