Spontaneous congenital parallel shunting of the gastrointestinal tract: flow-dynamic complications

Abstract

Four cases of anomalous congenital channelling of the gastrointestinal (GI) tract observed in children between the ages of 1 day and 6 months are presented. The first, a rare anomaly whereby the openings of ileum, appendix, urachus, a short patent ductus omphaloentericus, and the entrance into the ascending colon coalesce and open at the umbilicus, was designated as a confluent ileocecal junction. The second and third were associations of a patent ductus omphaloentericus with a short-circuiting entero-enteric H-fistula of the terminal ileum and a mucosal prolapse of the ductus. The fourth was a simultaneous occurrence of long-segment atresia of the ileum with gastrocolic, ileocolic, and jejunocolic fistula. Using the analogy of a network of fluid-carrying pipes, the complications and differential diagnosis of these anomalies are discussed with reference to the resultant directions of flow of the intestinal contents caused by parallel shunting from the multiplication of channelling and introduction of junctional points into the single-channelled GI tract.