Perforation of duplicated bowel in children.

Case 1. A male, who had melaena at 31 months and again a fortnight later, was admitted to hospital on December 26, 1958, when 14 months old. He was shocked with a vague mass across the lower abdomen. On the following day, after a blood transfusion, laparotomy was carried out and perforation of the ileum was closed. Penetration of rectus sheath was present. Occult blood remained positive. A second operation was performed on March 11, 1959. Meckel's diverticulum six inches distal to previous perforation was removed. This showed superficial ulceration, but no ectopic gastric mucosa was found. Occult blood became negative, but melaena recurred on April 24. (Haemoglobin was 48% with abdominal distension.) On May 1, 1959, a third operation was done, and duplicated bowel with its attached ileum was removed and end-to-end anastomosis carried out. Enterogenous cyst was seen about four inches above the duplication. Convalescence was uneventful. The specimen was 30 inches long and contained another ulcer at the point of perforation. No gastric mucosa was found on section. The ulcer was considered to be pyogenic. Frequent colicky abdominal pain persisted, but no further bleeding occurred. A fourth operation was carried out on July 13, 1960, when enterogenous cyst was removed without opening the ileum or interfering with its blood supply. No further abnormality of the bowel was discovered. He was symptom-free at follow-up. Section showed tall, columnar epithelium, muscularis mucosa and circular and longitudinal muscle coats.