Colonic duplication presenting as a huge abdominal mass in an adult female

Duplication of the transverse colon in adults: a case report and literature review

Background

Duplication of the transverse colon is a rare gastrointestinal malformation. Its pathogenesis is still unclear, and it is extremely rare in adults. Patients often present with symptoms of tumor compression such as abdominal mass, abdominal pain, and constipation as the first manifestation.

Methods and result

A patient with a duplication of the transverse colon was admitted to the Department of General Surgery of our hospital. Laparoscopic exploration found a mass at the rear of the transverse colon near the splenic flexure, and the root was connected to the middle portion of the transverse colon.

Conclusion

Surgery is a radical treatment and reduces the possibility of perforation, bleeding, obstruction, and cancer.

Clinical features of colorectal duplication in children: A study of 25 cases

PURPOSE

To describe the clinical features and surgical management of pediatric colorectal duplication.

METHODS

Twenty-five patients with colorectal duplication at Beijing Children's Hospital between January 2010 and December 2020 were reviewed. Colorectal duplications were divided into cystic, diverticular, tubular and mixed types according to shape.

RESULTS

Of the patients, 64% were female, and 44% had accompanying malformations. Abnormal prenatal ultrasound findings (24%), abnormalities immediately found after birth (28%), and postnatal subjective symptoms (48%) were the main clinical presentations. Cystic lesions were observed in 16 patients (64%), including 12 in the colon and 4 in the rectum. Diverticular lesions were observed in 4 patients (16%), and all originated from the sigmoid colon. Among the 4 patients (16%) with tubular lesions, 3 involved the total colon, and the other originated from the splenic flexure to the proximal sigmoid colon. The patient with mixed duplication presented an intact enteric cyst within tubular duplication of the total colon. The mean age at surgery was 20 (0.3-130) months. Except for 4 total colon duplications, complete surgical resection of duplication lesions was performed in all patients. The "distal cross-section, mucosa stripping, and closure" procedure was performed in 3 patients with total colon duplication. Eighteen patients (72%) were followed up for a median time of 54.5 (5-129) months and recovered uneventfully.

CONCLUSIONS

Owing to various clinical presentations, colorectal duplication requires careful preoperative differential diagnosis. Complete surgical resection is the preferred radical method for treating cystic, diverticular and short tubular colorectal duplications, except for total colon duplications.

LEVEL OF EVIDENCE

Level IV.

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

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.

Sigmoid colon duplication with ectopic immature renal tissue in an adult: A case report

BACKGROUND

Colonic duplication is a rare congenital anomaly. Many types of heterotopic tissue were identified within the wall of duplication. However, studies of ectopic immature renal tissue (EIRT) involving colon duplication in an adult have yet to be reported.

CASE SUMMARY

A 23-year-old woman visited our hospital with symptoms of recurrent abdominal pain and chronic constipation. Image analysis via abdomino-pelvic computed tomography, Gastrografin contrast study, and colonoscopy showed a blind and dilated bowel loop filled with fecal material located on the mesenteric side of the sigmoid colon. We established a diagnosis of sigmoid colon duplication and decided to perform a laparoscopic investigation. Segmental resection of the sigmoid colon with duplication was done. Microscopically, the duplicated segment showed all three layers of the bowel wall and EIRT in the wall of the duplication. The postoperative period was uneventful and the patient was discharged nine days after the surgery without complications. She has been doing well 12 mo after the follow-up period.

CONCLUSION

A comprehensive histopathologic examination for ectopic tissues or tumors is mandatory after resection of colon duplication.

Successful management of tubular colonic duplication using a laparoscopic approach: A case report and review of the literature

BACKGROUND

Alimentary duplication is a rare congenital disease with a reported incidence of 1 per 4500 persons, although the exact incidence has been difficult to ascertain. According to previous reports, the most common site of duplication is the ileum, and colonic duplication is rare. Due to different types and locations of the duplication, the manifestations are varied, which makes establishing an accurate diagnosis before surgery a challenge.

CASE SUMMARY

A 17-year-old female patient sought evaluation in our department with constipation and chronic abdominal pain for 12 years; she had difficulty defecating and had dry stools since she was a child. An abdominal computed tomography revealed two extremely enlarged loops of bowel full of stool-like intestinal contents in the left lower abdomen, which led us to consider the possibility of colonic duplication. A laparoscopic exploration was performed, which revealed a tubular duplicated colon that shared a common opening with the transverse colon. A left hemi-colectomy was performed with a side-to-side anastomosis. The pathologic results confirmed the diagnosis. At the 6-mo follow-up, the patient was doing well without constipation or abdominal pain.

CONCLUSION

Colonic duplication is a rare alimentary abnormality in adults. Due to the non-specific manifestations and low incidence, it is usually difficult to make an accurate diagnosis pre-operatively. Surgery is the mainstay of treatment, even though some patients are asymptomatic.