Complete foregut duplication

Alimentary tract duplications are rare congenital anomalies with the majority identified in the pediatric age group. However, duplications may be seen in the adult population and require operative excision. A 53-year-old man was seen with vague, nonspecific symptoms and was found to have a complete esophageal and gastric duplication with communication to the normal alimentary tract. Appropriate-for-structure epithelium was noted throughout the length of the duplication.     

Complete duplication of urethra

Complete duplication of the urethra with a single bladder is an exceptional finding. The anomalous urethral canal originates from the bladder separately, runs parallel and usually dorsal to the normally situated urethra, and opens on the dorsum of the penis. To our knowledge there are 41 reported cases of this anomaly. We present 2 cases of complete urethral duplication originating from a single bladder, one in a male patient and the other in a female. It is concluded that conservative therapy is the treatment of choice, and that surgery should be reserved for incontinent patients only. The complications of surgery have been emphasized.     

A duodenal duplication cyst communicated with an accessory pancreatic duct

We treated a 49 year-old women with acute pancreatitis, in whom there was an accessory pancreatic duct which opened into a duodenal duplication cyst. Epigastric pain associated with vomiting and fever were present. Laboratory data showed leukocytosis and hyperamylasemia. An upper G-I series revealed a stricture at the pyloric region. At operation a spherical mass of 6 cm in diameter was present between the greater curvature of the pyloric region and the head of the pancreas. The cyst was removed by hemigastrectomy and partial resection of the head of the pancreas. The accessory pancreatic duct opened into the cyst. Taking particular note of the communication with the pancreatic duct, this cyst was diagnosed as one of duodenal duplication. A duodenal duplication cyst communicating with the accessory pancreatic duct is rare and is dissimilar to any of the 20 cases of duodenal duplication reported in Japan since 1960.     

Complete epispadiac urethral duplication

A case of complete epispadiac urethral duplication is reported. The epispadiac opening was at the base of the penis. This case is unusual because the anatomy was otherwise normal and the incontinence was intermittent.     

Complete duplication of the colon

A case with complete tubular duplication of the colon is presented. The patient was a 1-year-old girl who had had defecation problems for 3 months. Successful surgical treatment was achieved by closing the vaginal fistula and creating an oval window on the common wall of the duplicated colon.     

Complete duplication of bladder and urethra

An unusual case of complete duplication of bladder and urethra is reported. The pertinent literature is reviewed and treatment discussed.     

Complete patent duplication of the urethra

We reviewed 16 patients with complete patent duplication of the urethra seen between 1945 and 1984. The clinical presentation, radiographic findings and management of each patient are presented. All 16 patients were symptomatic and a double stream was the most common complaint. An operation was necessary in 13 patients. Voiding cystourethrography and retrograde urethrography were necessary to define the anatomy completely and accurately in each patient. The ventral channel, regardless of the position of the meatus, invariably proved to be the more functional urethra.     

Complete bladder duplication presenting as incontinence in an 11-year-old girl

We describe the case of an 11-year-old girl with complete bladder duplication presenting as urinary incontinence. We discuss a unique surgical approach to the correction of her incontinence.     

Complete duplication of male urethra in children

Urethral duplication is a rare congenital anomaly. It may be complete or partial, and each form. has its distinctive anatomy, symptom complex, and surgical therapy. Surgical management, utilizing a penile retropubic-transvesical approach, is described.     

Hypermobility of the first ray

Hypermobility of the first ray is one of the causative components in common foot problems (such as hallux valgus) with a large intermetatarsal angle and metatarsus primus varus. Although not always associated with hallux valgus, hypermobility is a predisposing factor for this deformity, especially in conjunction with extrinsic factors, such as disruption of the plantar first metatarsal cuneiform ligament and tendon-muscle imbalance. Hypermobility is also frequently found in adolescents with hallux valgus, especially when associated with a large intermetatarsal angle. Motion at the first metatarsocuneiform joint occurs in the sagittal and transverse planes. Most studies agree that greater than 4 degrees and greater than 8 degrees, respectively, constitutes excessive motion. Clinically, hypermobility is evaluated by determining sagittal motion (the grasping test) and transverse motion (the clinical squeeze test) and by identifying signs such as the presence of a dorsal bunion, intractable plantar keratosis beneath the second metatarsal head, and arthritis of the first and second metatarsocuneiform joint. Radiographically, hypermobility is evaluated by measurements from the modified Coleman block test (for sagittal motion) and the radiographic squeeze test (for transverse motion) and by the identification of signs, such as cortical hypertrophy along the medial border of the second metatarsal shaft, a cuneiform split, the presence of os intermetatarseum, and the round shape and increased medial slope of the first metatarsocuneiform joint. Usually, treatment for hypermobility of the first ray is operative, but surgery is contraindicated for patients less than 20 years of age (especially when the epiphysis is not closed) and for patients with generalized ligamentous laxity, short first metatarsal, and arthritis of the hallux MTP joint. The authors' surgical treatment of choice is arthrodesis of the tarsometatarsal joint (as part of the hallux valgus correction), exostectomy, capsulorraphy, and distal soft tissue release to correct and stabilize the first metatarsal at the apex of the deformity. The authors have found it unnecessary to include the base of the second metatarsal. The main complications associated with the Lapidus procedure and its modifications are nonunion, malunion, and dorsal elevation of the first metatarsal. Although radiographic nonunion is the most frequent complication, only 25% of the patients with this condition have associated clinical findings; the results have been defined as good or excellent in two series. These results closely equal those in rheumatoid or sedentary patients managed with newer, modified, less traumatic techniques that stabilize the first metatarsocuneiform joint with screws rather than with arthrodesis.     

Complete duplication of the bladder and urethra.

We report a case of complete duplication of the bladder and urethra. The condition was asymptomatic and was associated with congenital dislocation of the right hip. Excision of the dorsal urethra and bladder, and correction of the chordee were done.