Chapter 21 (page 96)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 21 (page 96)

Duplications

True or complete duplication of the stomach or any other entire region of the gastrointestinal tract is exceedingly rare. More common (but also rare) incomplete duplications may be defined as spherical or tubular enteric formations which lie in contiguity with the normal alimentary tract and which share with it a common blood supply, and usually a common muscle coat (Abrami and Dennison l961). These cyst-like structures, or duplication cysts, usually do not communicate with the normal lumen. They may have a mucosal lining and may be pedunculated (Kammerer l969). They may occur along the entire alimentary tract, the most common site being the ileum and the least common the stomach (Abrami and Dennison l961; Kremer et al. l970). Over a 21 year period Sieber (l956) encountered 25 cases of gastrointestinal tract duplications, only 4 of which involved the stomach. Duplications of the pyloric region are particularly rare (Grosfeld et al. l970).

Duplication cyst of the stomach is a communicating or non-communicating cyst lined by gastric, intestinal or pancreatic epithelium, and usually located along the greater curvature (Kremer et al. l970). Occasionally it may be situated in the wall of the pyloric region; in such cases encroachment on the lumen may produce gastric outlet obstruction (Grosfeld et al. l970), or an appearance resembling infantile hypertrophic pyloric stenosis (Abrami and Dennison l96l; Kammerer l969). In non-communicating duplication cysts accumulation of acid and pepsin may produce a local inflammatory reaction, perforation, abscess formation and peritonitis; this was seen in 6 of 9 patients described by Kremer et al. (l970).

Discussion

Gastric duplication does not appear to be related anatomically to the pyloric sphincteric cylinder.

References

Abrami G, Dennison WM. Duplication of the stomach. Surgery l96l, 49, 794-801.
Grosfeld JL, Boles ET, Reiner C. Duplication of pylorus in the newborn: a rare cause of gastric outlet obstruction. J Ped Surg l970, 5, 365-369.
Grosfeld JL, O'Neill JA, Clatworthy HW. Enteric duplications in infancy and childhood: an l8 year review. Ann Surg l970, 172, 83-90.
Kammerer GT. Duplication of stomach resembling hypertrophic pyloric stenosis. J Amer Med Assoc l969, 207, 2101-2102.
Kremer RM, Lepoff RB, Izant RJ. Duplication of the stomach. J Pediat Surg l970, 5, 360-364.
Sieber WK. Alimentary tract duplications. Arch Surg l956, 73, 383- 392.