Cystic duplication of the intestine in a 2-month-old child complicated by intestinal obstruction due to enteritis: a clinical case

Doubling of the digestive tract (duplication cysts, enterocystomas) is a rare malformation, which in some cases is manifested as complications. Most digestive tract doublings are detected antenatally, and during the first two years of life they are detected due to some symptomatic course or randomly, not at targeted examinations. Sometimes doubling can be manifested as intestinal obstruction, gastrointestinal bleeding, perforation, and more rarely, malignancy. The article presents a clinical case of cystic doubling of the ileum, manifested by intestinal obstruction during norovirus enteritis in an infant. Doubling of the gastrointestinal tract was diagnosed antenatally: child's mother was consulted by a surgeon, and planned surgical treatment was recommended. At the age of two months, the child was admitted to the hospital with symptoms of intestinal infection; norovirus enteritis was diagnosed with lab tests. Ultrasound examination of the abdominal cavity revealed a cystic layered inclusion in the projection of the colon hepatic angle. A clinical picture of intestinal obstruction developed within one day. Due to the pronounced swollen intestinal loops and a high risk of injury, the laparotomy was made after preoperative preparation. A cystic formation was found in the ileocecal angle, which had a common wall with the ileum and was completely blocking the ileum lumen. The ascending colon was collapsed. This cystic doubling of the ileum caused small intestinal obstruction. Enterocyst fenestration was performed―2/3 of the cyst wall was removed. The early postoperative period was uneventful. Histological examination confirmed a duplicated cyst of the ileum. An elective surgery would have reduced intraoperative risks and allowed to perform a minimally invasive intervention. However, intramural doubling obturation did not lead to ischemic changes in the intestinal wall, that is why the surgery was performed simultaneously, without resection of intestinal segments. The present observation highlights the need for elective surgical correction of even asymptomatic, randomly detected doubling. Clinical manifestations may be triggered by intestinal infection, thus leading to emergency surgical tactics under developed complications.