Detection of small intestine duplication in a 16-year-old girl using small bowel enteroscopy without balloon assistance

A 16-year-old girl, a high school student, presented with a 2-year history of intermittent pain in the left upper abdomen. Routine laboratory tests performed at the time of admission were normal. Contrast-enhanced abdominal computed tomography revealed an intussusception-like appearance at the duodenojejunal junction ([Fig. 1]).

Fig. 1 Contrast-enhanced abdominal computed tomography revealing an intussusception-like appearance (arrow) of the duodenojejunal junction.

The patient underwent small bowel enteroscopy without balloon assistance, which revealed a large submucosal lesion at the duodenojejunal junction, measuring approximately 5 × 3 cm. The lesion had a smooth mucosal surface with a depressed area on the oral side ([Fig. 2], [Video 1]). Surgical resection was subsequently performed. Intraoperatively, a soft, mobile mass located near the ligament of Treitz in the jejunum was excised for pathological examination. Pathological analysis showed ectopic gastric mucosa, including gastric pits and fundic glands, within normal small intestinal mucosa, with mature cellular differentiation. Additionally, a duplicated segment of the digestive tract lined by gastric mucosa and pseudostratified ciliated columnar epithelium, surrounded by a complete muscularis mucosae, was identified ([Fig. 3]). A final diagnosis of small bowel duplication was established. Postoperatively, the patient experienced no recurrence of abdominal pain.

Fig. 2 A large submucosal lesion, measuring approximately 5 × 3 cm, located at the duodenojejunal junction is shown, with a smooth mucosal surface and a depressed area on the oral side.

Small intestinal duplication located at the duodenojejunal junction was detected by small bowel enteroscopy without balloon assistance in a 16-year-old girl with intermittent abdominal pain.Video 1

Fig. 3 Microscopic examination revealed ectopic gastric mucosa with gastric pits and fundic glands located within normal small intestine mucosa, exhibiting mature cellular differentiation. Additionally, a duplicated segment of the digestive tract lined with gastric mucosa and pseudostratified ciliated columnar epithelium, surrounded by a complete muscularis mucosae, was observed (magnification: 4×).

Gastrointestinal duplications are rare congenital anomalies, usually found in children, with a higher incidence in boys, typically within the first 2 years of life [1] [2]. Approximately 2–12% of small bowel duplications occur in the duodenum, 44% in the ileum, and 50% in the jejunum [3]. The clinical presentation depends on the duplication size and epithelial type. Duplications lined with gastric epithelium can secrete acid, leading to ulceration, gastrointestinal bleeding, or acute abdomen in cases of perforation. Other symptoms may include chronic abdominal pain, nausea, vomiting, jaundice, pancreatitis, and an abdominal mass [4] [5]. Preoperative diagnosis remains challenging; however, advancements in small bowel enteroscopy allow for precise detection. In this case, enteroscopy provided a clear and comprehensive view of the jejunal lesion. This case will assist endoscopists in promptly diagnosing this condition in the future.

Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AZ

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

Thank Dr. Liu Xiaosun for the surgical management of this case, Dr. Li Jun for the thorough analysis of the pathology, and Director Chen Hongtan for the support in publishing this paper.

• References

• 1 Fiorani C, Scaramuzzo R, Lazzaro A. et al. Intestinal duplication in adulthood: a rare entity, difficult to diagnose. World J Gastrointest Surg 2011; 3: 128-130
• 2 Holcomb GW, Gheissari A, O’Neill JA. et al. Surgical management of alimentary tract duplications. Ann Surg 1989; 209: 167-174
• 3 Liu R, Adler DG. Duplication cysts: diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound 2014; 3: 152-160
• 4 Niu BB, Bai YZ. Ileal tubular duplication in a 4-year-old girl. Surgery 2015; 157: 166-167
• 5 Arantes V, Nery SR, Starling SV. et al. Duodenal duplication cyst causing acute recurrent pancreatitis managed curatively by endoscopic marsuplialization. Endoscopy 2012; 44: E117-E118

Publikationsverlauf

Artikel online veröffentlicht:
14. Januar 2025