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Midgut volvulus.

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Child↗

Trisomy 13-15.

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Child, Preschool↗

Clinical and radiological findings in dominance of Santorini's duct.

BACKGROUND/AIMS: Few studies on Santorini's duct dominance, in which the ventral pancreatic duct is narrower than and anastomoses with Santorini's duct have been performed. We examined clinical and radiological findings in cases characterized by dominance of Santorini's duct. METHODS: We reviewed 3,800 cases of endoscopic retrograde cholangiopancreatography. Clinical and pancreatographic findings including caliber, course, terminal shape, and patency of Santorini's duct were examined in cases of Santorini's duct dominance. RESULTS: Twenty-nine cases were diagnosed as Santorini's duct dominant. Chronic pancreatitis, acute relapsing pancreatitis, pancreatic-type pain, and hyperamylasemia not associated with obvious pancreatitis were observed in 3, 1, 5, and 6 cases, respectively. Cholangiopancreatographic findings indicated congenital choledochal cyst (n = 2), branch fusion between the ventral and dorsal pancreatic ducts (n = 23), and normal pancreatic duct system characterized by a straight course through the body and tail to join the ventral pancreatic duct in the neck portion of the pancreas (n = 4). Regarding terminal shapes of Santorini's duct, cudgel type (n = 9) and spindle type (n = 8), which showed frequent patency, were observed significantly more frequently than in controls. Patency of Santorini's duct was observed in 90% (17/19). CONCLUSIONS: Many Santorini's duct-dominant cases exhibited branch fusion between the ventral and dorsal pancreatic ducts. Although Santorini's duct functions well in most cases in which it is dominant, pancreatitis or pancreatic-type pain occurs in half of such cases due to relative impairment of function of the minor duodenal papilla.

Cholangiopancreatography, Endoscopic Retrograde↗

Alimentary tract duplications in children: case and literature review.

This report reviews 11 alimentary tract duplications over a 25-year experience at Children's Hospital Medical Center of Akron, Ohio. The cases are compared and contrasted to the literature with respect to lesion, location, and patient presentation. There were no multiple duplications in this series. Clinical presentations were related to obstruction, abdominal pain, and/or hemorrhage. There were four foregut duplications, five midgut duplications, and two hindgut lesions. All patients were treated by surgical removal and all survived. One case was an incidental finding at appendectomy. Pooled data from five large series of duplications revealed the ileal region to be involved in 41 percent of all duplications, followed by esophageal (21%), gastroduodenal (12%), and jejunal (8%). Diverticular, recanalization, and split notochord theories of pathogenesis are discussed. The curious association between duplications and gastric mucosa is explored.

Adolescent↗