Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus

Hisham F. Bahmad; Luis E. Rosario Alvarado; Kiranmayi P. Muddasani; Ana Maria Medina

doi:10.4322/acr.2021.260

Clinical Case Report

Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus

Hisham F. Bahmad; Luis E. Rosario Alvarado; Kiranmayi P. Muddasani; Ana Maria Medina

http://dx.doi.org/10.4322/acr.2021.260 Autops Case Rep, vol.11, e2021260, 2021

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Abstract

Background: Intestinal duplications are rare congenital developmental anomalies with an incidence of 0.005-0.025% of births. They are usually identified before 2 years of age and commonly affect the foregut or mid-/hindgut. However, it is very uncommon for these anomalies, to arise in the colon or present during adulthood.

Case presentation: Herein, we present a case of a 28-year-old woman with a long-standing history of constipation, tenesmus, and rectal prolapse. Colonoscopy results were normal. An abdominal computed tomography (CT) revealed a diffusely mildly dilated redundant colon, which was prominently stool-filled. The gastrografin enema showed ahaustral mucosal appearance of the sigmoid and descending colon with findings suggestive of tricompartmental pelvic floor prolapse, moderate-size anterior rectocele, and grade 2 sigmoidocele. A laparoscopic exploration was performed, revealing a tubular duplicated colon at the sigmoid level. A sigmoid resection rectopexy was performed. Pathologic examination supported the diagnosis. At 1-month follow-up, the patient was doing well without constipation or rectal prolapse.

Conclusions: Tubular colonic duplications are very rare in adults but should be considered in the differential diagnosis of chronic constipation refractory to medical therapy. Due to the non-specific manifestations of this entity, it is rather challenging to make an accurate diagnosis pre-operatively. Surgery remains the mainstay of treatment. Some reports suggest that carcinomas are more prone to develop in colonic/rectal duplications than in other GI tract duplications.

Keywords

Case Reports, Congenital Abnormalities, Constipation, Diverticulum, Colon

References

1 Polydorides AD. Colon: colonic duplications, cysts, and congenital diverticula. In: Greenson JK, editor. Diagnostic pathology: gastrointestinal. 3rd ed. London: Elsevier Health Sciences; 2019. p. 364-5. Section 5.

2 Hackam DJ, Zalev A, Burnstein M, Rotstein OD, Koo J. Enteric duplication in the adult, derived from the foregut, midgut and hindgut: presentation, patterns and literature review. Can J Surg. 1997;40(2):129-33. PMid:9126127.

3 Holcomb GW 3rd, Gheissari A, O’Neill JA Jr, Shorter NA, Bishop HC. Surgical management of alimentary tract duplications. Ann Surg. 1989;209(2):167-74. http://dx.doi.org/10.1097/00000658-198902000-00006. PMid:2916861.

4 Mourra N, Chafai N, Bessoud B, Reveri V, Werbrouck A, Tiret E. Colorectal duplication in adults: report of seven cases and review of the literature. J Clin Pathol. 2010;63(12):1080-3. http://dx.doi.org/10.1136/jcp.2010.083238. PMid:20924093.

5 Smith JR. Accessory enteric formations: a classification and nomenclature. Arch Dis Child. 1960;35(179):87-9. http://dx.doi.org/10.1136/adc.35.179.87. PMid:13832044.

6 Wu X, Xu X, Zheng C, Li B. Tubular colonic duplication in an adult: case report and brief literature review. J Int Med Res. 2018;46(7):2970-5. http://dx.doi.org/10.1177/0300060518773016. PMid:29761727.

7 Asour A, Kim H-K, Arya S, Hepworth C. Tubular sigmoid duplication in an adult man: an interesting incidental finding. BMJ Case Rep. 2017;2017:bcr2017219474. http://dx.doi.org/10.1136/bcr-2017-219474. PMid:29133579.

8 Cheng KC, Ko SF, Lee KC. Colonic duplication presenting as a huge abdominal mass in an adult female. Int J Colorectal Dis. 2019;34(11):1995-8. http://dx.doi.org/10.1007/s00384-019-03409-9. PMid:31642971.

9 Domajnko B, Salloum RM. Duplication cyst of the sigmoid colon. Gastroenterol Res Pract. 2009;2009:918401. http://dx.doi.org/10.1155/2009/918401. PMid:20169095.

10 Russo P, Huff D. Congenital and developmental disorders of the GI tract. In: Odze RD, Goldblum JR, editors. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. 2nd ed. Philadelphia: W.B. Saunders; 2009. p. 145-68. Chapter 8. http://dx.doi.org/10.1016/B978-141604059-0.50011-4.

11 Bentley JF, Smith JR. Developmental posterior enteric remnants and spinal malformations: the split notochord syndrome. Arch Dis Child. 1960;35(179):76-86. http://dx.doi.org/10.1136/adc.35.179.76. PMid:13799033.

12 Srivastava P, Gangopadhyay AN, Gupta DK, Sharma SP. Split notochord syndrome associated with dorsal neuroenteric fistula: A rare entity. J Pediatr Neurosci. 2010;5(2):135-7. http://dx.doi.org/10.4103/1817-1745.76112. PMid:21559161.

13 Sur A, Paria A, Sardar SK. Caudal duplication syndrome. J Clin Neonatol. 2013;2(2):101-2. http://dx.doi.org/10.4103/2249-4847.116412. PMid:24049755.

14 Dominguez R, Rott J, Castillo M, Pittaluga RR, Corriere JN Jr. Caudal duplication syndrome. Am J Dis Child. 1993;147(10):1048-52. http://dx.doi.org/10.1001/archpedi.1993.02160340034009. PMid:8213674.

15 Kang M, An J, Chung DH, Cho HY. Adenocarcinoma arising in a colonic duplication cyst: a case report and review of the literature. Korean J Pathol. 2014;48(1):62-5. http://dx.doi.org/10.4132/KoreanJPathol.2014.48.1.62. PMid:24627698.

16 Fenelon C, Boland MR, Kenny B, Faul P, Tormey S. A colonic duplication cyst causing bowel ischaemia in a 74-year-old lady. J Surg Case Rep. 2016;2016(8):rjw147. http://dx.doi.org/10.1093/jscr/rjw147. PMid:27572680.

17 Sharma S, Yadav AK, Mandal AK, Zaheer S, Yadav DK, Samie A. Enteric duplication cysts in children: a clinicopathological dilemma. J Clin Diagn Res. 2015;9(8):EC08-11. http://dx.doi.org/10.7860/JCDR/2015/12929.6381. PMid:26435952.

18 Roberts M, Rabinovitch J, Felton M, Lerner R. Duplication of the sigmoid colon. Ann Surg. 1959;150(5):904-8. http://dx.doi.org/10.1097/00000658-195911000-00015. PMid:14437825.

19 Al-Jaroof AH, Al-Zayer F, Meshikhes AW. A case of sigmoid colon duplication in an adult woman. BMJ Case Rep. 2014;2014(1):bcr2014203874. http://dx.doi.org/10.1136/bcr-2014-203874. PMid:25096653.

Submitted date:
01/05/2021

Accepted date:
02/02/2021

Publication date:
05/06/2021

Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus

Hisham F. Bahmad; Luis E. Rosario Alvarado; Kiranmayi P. Muddasani; Ana Maria Medina

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