Echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania

Objective

To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods

Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital’s care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.

Results

A total of 102 patients were recruited from September 2009 to April 2010. The patients’ mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.

Conclusion

Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.     

Hepatic resection for metastatic endometrioid carcinoma

Background:

The role of hepatic resection for gynaecological tumours is not well defined as evidence on the subject is lacking. This article describes a tertiary hepatopancreatobiliary unit''s experience with hepatic resection for liver metastases from endometrioid primaries.

Methods:

Five women in whom liver metastases developed at 11 months to 10 years post-primary resection are presented. These patients subsequently underwent hepatic resection with disease-free survival of 8–66 months post-resection.

Results:

Outcomes in this patient series support hepatic resection in the face of isolated liver metastasis.

Conclusions:

The authors advocate that patients with hepatic deposits should be referred to specialist hepatobiliary units with a view towards hepatic resection and a subsequent good outcome.     

Surgical management of hepatic hemangiomas: a multi-institutional experience

Background

The management of hepatic hemangiomas remains ill defined. This study sought to investigate the indications, surgical management and outcomes of patients who underwent a resection for hepatic hemangiomas.

Methods

A retrospective review from six major liver centres in the United States identifying patients who underwent surgery for hepatic hemangiomas was performed. Clinico-pathological, treatment and peri-operative data were evaluated.

Results

Of the 241patients who underwent a resection, the median age was 46 years [interquartile range (IQR): 39–53] and 85.5% were female. The median hemangioma size was 8.5 cm (IQR: 6–12.1). Surgery was performed for abdominal symptoms (85%), increasing hemangioma size (11.3%) and patient anxiety (3.7%). Life-threatening complications necessitating a hemangioma resection occurred in three patients (1.2%). Clavien Grade 3 or higher complications occurred in 14 patients (5.7%). The 30- and 90-day mortality was 0.8% (n = 2). Of patients with abdominal symptoms, 63.2% reported improvement of symptoms post-operatively.

Conclusion

A hemangioma resection can be safely performed at high-volume institutions. The primary indication for surgery remains for intractable symptoms. The development of severe complications associated with non-operative management remains a rare event, ultimately challenging the necessity of additional surgical indications for a hemangioma resection.     

When should a liver resection be performed in patients with liver metastases from neuroendocrine tumours? A systematic review with practice recommendations

Aim

To determine the benefits and risks of hepatic resection versus non-resectional liver-directed treatments in patients with potentially resectable neuroendocrine liver metastases.

Methods

A systematic review identified 1594 reports which alluded to a possible liver resection for neuroendocrine tumour metastases, of which 38 reports (all retrospective), comprising 3425 patients, were relevant.

Results

Thirty studies reported resection alone, and 16 studies reported overall survival (OS). Only two studies addressed quality-of-life (QoL) issues. Five-year overall survival was reported at 41–100%, whereas 5-year progression-free survival (PFS) was 5–54%. We identified no robust evidence that a liver resection was superior to any other liver-directed therapies in improving OS or PFS. There was no evidence to support the use of a R2 resection (debulking), with or without tumour ablation, to improve either OS or QoL. There was little evidence to guide sequencing of surgery for patients presenting in Stage IV with resectable disease, and none to support a resection of asymptomatic primary tumours in the presence of non-resectable liver metastases.

Conclusion

Low-level recommendations are offered to assist in the management of patients with neuroendocrine liver metastases, along with recommendations for future studies.     

Surgical treatment of gastrinomas: a single-centre experience

Background

Gastrinomas are rare neuroendocrine tumours, and responsible for Zollinger–Ellison syndrome (ZES). Surgery is the only treatment that can cure gastrinomas. The success of surgical treatment of gastrinomas in a single centre was evaluated.

Methods

A retrospective review of all patients who underwent resection for a gastrinoma between 1992 and 2011 at a single institution was performed. Presentation, diagnostics, operative management and outcome were analysed.

Results

Eleven patients with a median age of 46 years were included. All patients had fasting hypergastrinaemia and a primary tumour was localized using imaging studies in all patients. A pylorus-preserving pancreaticoduodenectomy was performed in three patients: two patients underwent duodenectomy and one patient central pancreatectomy. The remaining five patients underwent enucleation. A primary tumour was removed in nine patients: five tumours were situated in the pancreas, three in the duodenum and one patient was considered to have a primary lymph node gastrinoma. The median follow-up was 3 years (range 1–15) after which 7 patients were disease-free and 3 patients had (suspected) metastatic disease. One patient died 13 years after initial surgery.

Conclusion

The success of surgical treatment of a gastrinoma in this series was 7/11 with a median follow-up of 3 years; comparable to recent published studies.     

Changes in the management of benign liver tumours: an analysis of 285 patients

Objectives

Benign liver tumours (BLTs) are common and their management remains controversial. This study assesses the safety of a selective management approach.

Methods

Patients with BLT were identified from an institutional database. Patients with simple cysts or an incidental BLT in the setting of metastasis or concomitant malignancy were excluded.

Results

A total of 285 patients presenting during the period from January 1992 to December 2009 with haemangioma (53.0%), focal nodular hyperplasia (23.9%), adenoma (10.2%) or indeterminate/other lesions (13.0%) were evaluated. Of these, 117 patients (41.1%) underwent immediate resection and 168 patients (58.9%) were followed with serial imaging (median follow-up: 30 months). During observation, eight patients (4.8%) underwent resection for tumour growth, inability to exclude malignancy or symptoms; no patients demonstrated malignant transformation or tumour-related complications. During the study period, the number of BLTs evaluated and the proportion of patients observed increased from 129 BLTs of which 36.4% were observed in 1992–2002 to 156 BLTs of which 71.2% were observed in 2003–2009 (P < 0.001). Diagnostic uncertainty led to resection in 29.5% of patients during the earlier period, but in only 13.4% during the more recent 7 years (P < 0.05).

Conclusions

Asymptomatic BLTs without concern for malignancy or adenoma can be safely observed with minimal risk for misdiagnosis. Patients selected for observation rarely require resection or develop tumour-related complications.     

The value of serum tumour markers in the prediction of aetiology and follow up of patients with pericardial effusion

Background

The aim of this study was to evaluate the value of tumour markers in the differential diagnosis of pericardial effusions and to assess their changing levels during follow up.

Methods

Sixty-nine patients who were admitted to hospital with a diagnosis of pericardial effusion were included in the study. Serum tumour markers were measured on admission and after a mean of 18 ± 7 months’ follow up. An aetiological diagnosis was made on clinical evaluation, imaging techniques and biochemical, microbiological and pathological analysis. The patients were divided into five groups according to the aetiology of their pericardial effusions.

Results

Carbohydrate antigen (CA) 12-5 and CA 15-3, and carcinoembryonic antigen (CEA) levels were significantly higher in patients with malignancies than in those with viral/idiopathic pericarditis. With multivariate analysis, CA 15-3 levels were found to be the most significant determinant (p = 0.027). In the ROC curve analysis, CA 15-3 values above 25 U/ml predicted a malignancy with 71% sensitivity and 78% specificity.

Conclusion

Tumour markers, particularly CA 15-3, may be useful in the differential diagnosis and prediction of malignancies in patients with pericardial effusion. In patients with viral/idiopathic aetiology, these serum tumour markers were slightly elevated in the acute phase, but after a mean of one year of follow up, their levels returned to normal, contrary to those with malignancies.     

Intra-operative microwave ablation of liver malignancies with tumour permittivity feedback control: a prospective ablate and resect study

Background

Tumour permittivity feedback control is a novel method for microwave ablation (MWA) that theoretically allows for larger, more predictable ablations. This prospective case series evaluates the feasibility and efficacy of MWA of liver malignancies using a device with tumour permittivity feedback control.

Methods

Ten consecutive patients initially determined to be candidates for surgical resection of a liver malignancy underwent intra-operative MWA with tumour permittivity feedback control followed by a surgical resection. A 14-gauge Medwaves microwave antenna was used to deliver a single treatment according to the manufacturer''s recommendations. Tumours were assessed grossly as well as by haematoxylin and eosin (H&E) and tetrazolium chloride staining. The primary end point was per cent tumour necrosis.

Results

The median maximum ablation diameter measured was 4.1 cm (range 3.0–6.8). The median ablation volume was 8.7 cm³ (range 4.84–17.55). Six of the 10 tumours demonstrated a pathological complete response (CR). Six of seven tumours ≤3 cm demonstrated a pathological CR. Zero of the three tumours ≥3 cm had a pathological CR, but all had ≥50% tumour necrosis. All patients survived and there were no ablation-related morbidities.

Discussion

MWA of liver tumours with tumour permittivity feedback control is feasible and appears effective for the treatment of small (<3 cm) liver tumours.     

Surgical management and longterm follow-up of non-parasitic hepatic cysts

Background:

Despite the increasing use of laparoscopic techniques, the optimal surgical approach for cystic liver disease has not been well defined. This study aims to determine the optimum operative approach for these patients.

Methods:

Data were identified from the Lothian Surgical Audit, case note review and general practitioner contact. Patients were contacted and asked to complete the SF-36 questionnaire on quality of life.

Results:

A total of 102 patients (67 with simple cysts, 31 with polycystic liver disease [PCLD], four with cystic tumours) underwent 62 laparoscopic deroofings, 15 open deroofings, 36 resections and one liver transplant between June 1985 and April 2006. The median follow-up was 77 months (range 3–250 months). Morbidity and recurrent symptom rates after laparoscopic surgery were greater in PCLD patients compared with simple cyst patients, at 31% (four patients) vs. 15% (seven patients) and 85% (11 patients) vs. 29% (24 patients), respectively. Four patients with simple cysts and eight with PCLD required further surgery. All patients with simple cysts had comparable quality of life after surgery. Patients with recurrent symptoms after surgery for PCLD had a significantly better quality of life following laparoscopic deroofing than after resection.

Conclusions:

Most simple cysts can be managed laparoscopically, but there is a definite role for open resection in some patients. Open deroofing is the preferred approach for a dominant cyst pattern in PCLD, whereas resection is necessary for diffuse cystic disease.     

Surgical management of effusive constrictive pericarditis

Background

The surgical approach for effusive constrictive pericarditis (ECP) has not been extensively studied. We present our institution’s early and long-term results of pericardiectomy in our cohort of patients with ECP.

Methods

Diagnosis was made primarily by echocardiography. Right heart catheterisation was performed in eight patients. Pre-operatively, 10 patients had undergone at least one previous attempt at therapeutic pericardiocentesis. Pericardiectomy was performed where appropriate (thickened or inflamed).

Results

Of our 12 patients (50% male, median age 48 years, range 17–72 years), the underlying aetiology included idiopathic in five (41.6%), tuberculosis in four (33%), and malignancy in three patients (25%). Elective surgery was performed in nine patients. Median values of both central venous pressure and pulmonary capillary wedge pressure decreased markedly postoperatively (from 16.5 to 11.0 mmHg, p = 0.02; 20.0–15.0 mmHg, p = 0.01, respectively). There was no in-hospital mortality. Follow up ranged from three months to nine years (median three years). Five (41.6%) patients died during the follow-up period, and cumulative two-year survival was 55.6 ± 1.5%.

Conclusion

Pericardiectomy for ECP was effective, in terms of our early results, in patients unresponsive to medical therapy. Long-term survival depends on the underlying disease.     

Hepatic resection for non-colorectal, non-neuroendocrine, non-sarcoma metastasis: a single-centre experience

Background

The aim of the present study was to analyse the outcome after hepatic resection for non-colorectal, non-neuroendocrine, non-sarcomatous (NCNNNS) metastatic tumours and to identify the factors predicting survival.

Methods

All patients who underwent hepatic resection for NCNNNS metastatic tumours between September 1996 and June 2009 were included. Patients'' demographics, clinical and histopathological parameters, overall survival and the factors predicting survival were analysed.

Results

In all, 65 patients underwent hepatic resection for metastasis. The most common site of a primary tumour was the kidney (24 patients). Fifteen patients had synchronous tumours. Fifty patients had major liver resections and 22 patients had bilobar disease. The median number of liver lesions resected was 1 and the median maximum diameter of the metastasis was 6 cm. A R0 resection was performed in 51 patients. The 1-, 3- and 5-year overall survival from the time of metastasectomy was 72.9%, 47.9% and 25.6%, respectively, with a median survival of 19 months. The presence of a tumour of greater than 6 cm (P = 0.048) and a positive resection margin (P = 0.04) were associated with poor survival.

Conclusion

Hepatic resection for metastasis from NCNNNS tumours can offer acceptable long-term survival in selected patients. To offer a chance of a cure a R0 resection must be performed.     

Refining indications for contemporary surgical treatment of renal cell carcinoma metastatic to the pancreas

Background:

The pancreas is a rare location for metastatic disease, with only 2–11% of all pancreatic tumours being of non-primary origin. It is also uncommon for renal cell carcinoma (RCC) to metastasize to the pancreas (1–3% of cases) and, when it does, it typically occurs substantially after index nephrectomy. It is not known whether all pancreatic metastases need be resected because today''s chemo- and biological therapies are increasingly effective in controlling advanced disease.

Methods:

Six patients with a variety of symptoms are discussed. Four patients presented with recurrent gastrointestinal bleeding, ranging from occult to life-threatening in severity.

Results:

The four patients with gastrointestinal bleeding had RCC metastases that had eroded into the duodenum and were successfully controlled by palliative pancreaticoduodenectomy or completion pancreatectomy. The other two patients were treated using different chemotherapeutic or biological agents.

Conclusions:

Renal cell carcinoma metastases to the pancreas typically occur long after index nephrectomy. Although clinical presentation is variable, palliative resection should be reserved for those who develop complications, such as upper gastrointestinal bleeding, and, in other series, obstructive jaundice. Routine debulking resections do not appear to be indicated because current biological therapies effectively and reliably control disease over long periods.     

Open versus laparoscopic resection for liver tumours

Background:

The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections.

Methods:

Literature review on liver resection and laparoscopy.

Results:

There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case–control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection.

Discussion:

The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection.     

Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data

Background

Postoperative infections are frequent complications after liver resection and have significant impact on length of stay, morbidity and mortality. Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, accounting for 38% of all such infections.

Objectives

This study aimed to identify predictors of SSI and organ space SSI after liver resection.

Methods

Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS–NSQIP) database for patients who underwent liver resection in 2005, 2006 or 2007 in any of 173 hospitals throughout the USA were analysed. All patients who underwent a segmental resection, left hepatectomy, right hepatectomy or trisectionectomy were included.

Results

The ACS–NSQIP database contained 2332 patients who underwent hepatectomy during 2005–2007. Rates of SSI varied significantly across primary procedures, ranging from 9.7% in segmental resection patients to 18.3% in trisectionectomy patients. A preoperative open wound, hypernatraemia, hypoalbuminaemia, elevated serum bilirubin, dialysis and longer operative time were independent predictors for SSI and for organ space SSI.

Conclusions

These findings may contribute towards the identification of patients at risk for SSI and the development of strategies to reduce the incidence of SSI and subsequent costs after liver resection.     

The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

Background

Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection.

Methods

Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed.

Results

A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively.

Conclusions

The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation.     

Clinicopathologic analysis of cardiac myxomas: Seven years' experience with 61 patients

Objective

Cardiac myxomas are the most common primary neoplasms of heart. The present study was performed on the 61 cases of patients with cardiac myxoma, in order to investigate the tumors’ clinical and pathological features, and to identify the relationship between the pathological characteristics and clinical behaviors.

Methods

A total of 61 cardiac myxoma cases were analyzed and reviewed retrospectively, including the clinical presentations, physical examinations, and echocardiography, electrocardiography, and pathology documents.

Results

The total patient cohort was made up of 37 women and 24 men. The average age at diagnosis was 48.8 years in males and 51.9 years in females. The most common complaint was dyspnea (37 cases, 60.7%) and the most common sign was systolic murmur (30 cases, 49.2%). Two surface structures and three tumor cell arrangement patterns were observed, and statistical analysis revealed the surface structure was related to the cell arrangement pattern. However, neither the cell arrangement pattern nor the tumor surface structure showed a significant correlation with the clinical presentation.

Conclusions

The present study showed the pathological profiles of cardiac myxomas were not related to the clinical presentations. The results of our study indicate morphologic classifications of cardiac myxomas may not be significant for clinical practice.Key Words: Cardiac neoplasms, myxoma, immunohistochemistry, pathology, surgical, neoplasm recurrence, local     

Pattern of congestive heart failure in a Kenyan paediatric population

Background

Heart failure in children is a common cause of morbidity and mortality, with high socio-economic burden. Its pattern varies between countries but reports from Africa are few. The data are important to inform management and prevention strategies.

Objective

To describe the pattern of congestive heart failure in a Kenyan paediatric population.

Methods

This was a retrospective study done at Kenyatta National Hospital, Nairobi Kenya. Records of patients aged 12 years and younger admitted with a diagnosis of heart failure between January 2006 and December 2010 were examined for mode of diagnosis, age, gender, cause, treatment and outcome. Data were analysed using the Statistical Programme for Social Scientists version 16.0 for windows, and presented in tables, bar and pie charts.

Results

One hundred and fifty-eight cases (91 male, 67 female) patients’ records were analysed. The mean age was 4.7 years, with a peak at 1–3 years. The male:female ratio was 1.4:1. All the cases were in New York Heart Association (NYHA) class II–IV. Evaluation of infants was based on the classification proposed by Ross et al. (1992). Diagnosis was made based on symptoms and signs combined with echocardiography (echo) and electrocardiography (ECG) (38%); echo alone (12.7%); ECG, echo and chest X-ray (CXR) (11.4%); and ECG alone (10.8%). The underlying cause was established on the basis of symptoms, signs, blood tests, CXR, echo and ECG results. Common causes were infection (22.8%), anaemia (17.1%), rheumatic heart disease (14.6%), congenital heart disease (13.3%), cardiomyopathy (7.6%), tuberculosis and human immunodeficiency virus (6.9% each); 77.9% of patients recovered, 13.9% after successful surgery, and 7.6% died.

Conclusion

Congestive heart failure is not uncommon in the Kenyan paediatric population. It occurs mainly before five years of age, and affects boys more than girls. The majority are due to infection, anaemia, and rheumatic and congenital heart diseases. This differs from those in developed countries, where congenital heart disease and cardiomyopathy predominate. The majority of children usually recover. Prudent control of infection and correction of anaemia are recommended.     

Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion

Background

We aimed to assess graft patency in patients undergoing prosthetic graft interposition of the brachiocephalic veins (BCVs) or the superior vena cava (SVC) combined with resection of malignant tumours.

Methods

A retrospective analysis was conducted on 16 patients who underwent prosthetic graft interposition of the BCVs or the SVC between 1998 and 2012.

Results

Among a total of 20 grafts in 16 patients (unilateral graft interposition in 12, bilateral graft interposition in 4), 8 grafts were occluded in 8 patients. Overall graft patency rate was 64.6%, 42.4% at the 2- and 5-year follow-up. Graft patency rate of the left BCV was significantly lower than that of the right BCV or the SVC (2-year patency, 38.1% vs. 81.8%, P=0.024). In univariate analysis, the superior anastomosis site [left BCV vs. right BCV; hazard ratio (HR) =2.312; 95% confidence interval (CI), 1.015–5.265; P=0.046], the inferior anastomosis site (right atrial appendage vs. SVC; HR =2.409; 95% CI, 1.124–5.161; P=0.024), and interruption of warfarin (HR =5.015; 95% CI, 1.106–22.734; P=0.037) were significant risk factors for graft occlusion. Graft occlusive symptoms were identified in 4 patients who underwent unilateral graft interposition.

Conclusions

Prosthetic graft interposition between the left BCV and the right atrial appendage resulted in a significant rate of graft occlusion. Prosthetic graft interposition of the bilateral BCVs and long-term warfarin therapy may be necessary to prevent graft occlusive symptoms.     

Patterns of recurrence after resection of gallbladder cancer without routine extrahepatic bile duct resection

Objective

Routine extrahepatic bile duct (EBD) resection in non-jaundiced patients with gallbladder cancer (GBC) is controversial. The aim of this study was to retrospectively analyse patterns of recurrence in patients who underwent resection of GBC without routine EBD resection.

Methods

This analysis referred to 58 patients who had undergone explorative laparotomy for GBC during 2000–2012 at a single, tertiary referral centre. Overall survival, time to recurrence, and patterns of recurrence were assessed in patients who underwent conventional negative-margin (R0) resection without routine EBD resection.

Results

Of 58 patients submitted to explorative laparotomy for GBC, 26 (45%) patients underwent R0 resection without EBD resection (tumour stage T1b in five patients, T2 in 17, T3 in three, and T4 in one). The 3-year survival rate among these patients was 78% at a median follow-up of 33 months (range: 13–127 months). Seven patients developed recurrent disease at a median of 9 months (range: 2–25 months) after resection. No patients developed isolated recurrent disease at the EBD.

Conclusions

Of 26 patients resected for GBC, none developed isolated recurrent disease at the EBD after conventional resection of GBC without EBD resection. This finding suggests that routine EBD resection is of no additional value.     

Gastrointestinal Duplications: Experience in Seven Children and a Review of the Literature

Background/Aim:

Enteric duplication (ED) is a rare congenital anomaly that can occur anywhere along the alimentary tract from the mouth, down to the anus and the nearby organs. This uncommon anomaly may be asymptomatic or presents with vague symptoms mimicking other common pathologies. We aim to present our experience, management challenges and patterns of ED with a review of the literature.

Settings and Design:

The study was carried out at a Nigerian Tertiary Hospital (2005–2008 inclusive).

Materials and Methods:

We retrospectively analyzed seven patients with ED managed in our hospital for sex, age, clinical presentations, duplication size and site, presence of ectopic tissue, complications, associated anomalies, radiological workups, and prognosis. Data was analyzed using SPSS 11.0 for window.

Results:

Seven children between the age range of 44 hours–10 years had ED, one sublingual and six intraabdominal duplications. Midgut volvulus with long segment bowel gangrene complicated two cases. The diagnosis was incidental in all. Three cases were diagnosed following conventional radiological contrast examination and the rest at surgery. Ultrasound was not helpful in making diagnosis in all the six intraabdominal duplications. Though surgery was recommended for all, one of the patients declined. Only one patient had unsuccessful surgery.

Conclusions:

ED requires high index of clinical suspicion and careful management. Many cases of nonspecific abdominal pains should be properly evaluated before patients suffer avoidable complications.