Thoracoabdominal duplication with hematochezia as an onset symptom in a baby: A case report

BACKGROUND: Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract, whereas thoracoabdominal duplications only account for approximately 2% of all alimentary tract duplication cases. Many symptoms, including abdominal pain, abdominal distension, vomiting, gastrointestinal bleeding, chest discomfort, chest pain, and shortness of breath, may be present in patients with abdominal or thoracic duplication. CASE SUMMARY: A 10-mo-old infant, with a free previous medical history, was admitted to our hospital with melena three times in 6 d. Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities, spina bifida, meningomyelocele towards the posterior mediastinum, and possible concurrent infection. Upper gastroenterography indicated intestinal malrotation. A laparoscopic abdominal examination was performed, and the operation was intraoperatively converted to laparotomy. This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication. The intestinal duplications in the abdomen and large part of the thorax were excised. The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa. The infant recovered well and was discharged 1 wk after the surgery. A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced. CONCLUSION: Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.