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Kanbar M, Alomar K, Alkader MA, Alloun M, Al Dalati H, Alghazal LK. A unique case of complete tubular colonic duplication with normal anus accompanied by vestibular fistula in a 12 years _ old _ girl - A case report. Int J Surg Case Rep 2023; 108:108405. [PMID: 37352770 PMCID: PMC10382748 DOI: 10.1016/j.ijscr.2023.108405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Duplication of the digestive system is one of the rare cases, which can vary in shape and size and is cystic in 80 % of cases. Most cases of duplication are often diagnosed before the age of two years. There are many ways to make the diagnosis, with computed tomography being the best, and duplication is often diagnosed during surgery. CASE PRESENTATION We present the case of a child suffering from complete duplication of colon with normal anus, accompanied by vestibular fistula with double urethra and vagina. The diagnosis was made at our hospital, the necessary surgery was performed, and a future plan for the child's condition was developed. CLINICAL DISCUSSION: a colonic duplication may be associated with malformations of other organs, and sometimes it may be associated with a vestibular or vaginal fistula. Therefore, we must evaluate patients for other anomalies when diagnosing a duplication. The most appropriate diagnostic method is CT, and surgery is recommended in symptomatic or asymptomatic patients. CONCLUSION When keeping in mind the possibility of a duplication of the digestive system, the surgeon helps to plan the surgery well, in addition to the importance of informing the parents of the possibility of eradication.
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Affiliation(s)
| | - Khaled Alomar
- Damascus University, University pediatrics' Hospital, Syria.
| | | | - Maher Alloun
- Damascus University, University pediatrics' Hospital, Syria
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Bahmad HF, Alvarado LER, Muddasani KP, Medina AM. Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus. AUTOPSY AND CASE REPORTS 2021; 11:e2021260. [PMID: 34307222 PMCID: PMC8214887 DOI: 10.4322/acr.2021.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Hisham F Bahmad
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | | | | | - Ana Maria Medina
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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Namgung H. Sigmoid colon duplication with ectopic immature renal tissue in an adult: A case report. World J Clin Cases 2020; 8:6346-6352. [PMID: 33392316 PMCID: PMC7760449 DOI: 10.12998/wjcc.v8.i24.6346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/14/2020] [Accepted: 11/12/2020] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Hwan Namgung
- Department of Surgery, Dankook University College of Medicine, Cheonan 31116, South Korea
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Shrestha S, Adhikari SK. Colonic Duplication Cyst in an Adult Woman: A Case Report. JNMA J Nepal Med Assoc 2020; 58:948-950. [PMID: 34506427 PMCID: PMC7775001 DOI: 10.31729/jnma.5114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Indexed: 11/03/2022] Open
Abstract
Intestinal duplications are rare congenital anomaly found in the pediatric age group. Although, the ileum is the most common site, there are cases of colonic duplications even in the adult. Colonoscopy is a good investigation tool for the diagnosis of colonic duplications; however, it may not be true in all cases. We report a case of 43 years woman presented with chronic constipation, intermittent colicky abdomen pain, and a cystic lump in the left abdomen diagnosed as tubular duplication cyst of descending colon. She was managed with left hemicolectomy and excision of the cyst with uneventful postoperative days. This case has been reported as it is a rare condition.
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Affiliation(s)
- Sundar Shrestha
- Department of General Surgery, Bir Hospital, Kathmandu, Nepal
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Kostouros A, Koliarakis I, Natsis K, Spandidos DA, Tsatsakis A, Tsiaoussis J. Large intestine embryogenesis: Molecular pathways and related disorders (Review). Int J Mol Med 2020; 46:27-57. [PMID: 32319546 PMCID: PMC7255481 DOI: 10.3892/ijmm.2020.4583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
The large intestine, part of the gastrointestinal tract (GI), is composed of all three germ layers, namely the endoderm, the mesoderm and the ectoderm, forming the epithelium, the smooth muscle layers and the enteric nervous system, respectively. Since gastrulation, these layers develop simultaneously during embryogenesis, signaling to each other continuously until adult age. Two invaginations, the anterior intestinal portal (AIP) and the caudal/posterior intestinal portal (CIP), elongate and fuse, creating the primitive gut tube, which is then patterned along the antero‑posterior (AP) axis and the radial (RAD) axis in the context of left‑right (LR) asymmetry. These events lead to the formation of three distinct regions, the foregut, midgut and hindgut. All the above‑mentioned phenomena are under strict control from various molecular pathways, which are critical for the normal intestinal development and function. Specifically, the intestinal epithelium constitutes a constantly developing tissue, deriving from the progenitor stem cells at the bottom of the intestinal crypt. Epithelial differentiation strongly depends on the crosstalk with the adjacent mesoderm. Major molecular pathways that are implicated in the embryogenesis of the large intestine include the canonical and non‑canonical wingless‑related integration site (Wnt), bone morphogenetic protein (BMP), Notch and hedgehog systems. The aberrant regulation of these pathways inevitably leads to several intestinal malformation syndromes, such as atresia, stenosis, or agangliosis. Novel theories, involving the regulation and homeostasis of intestinal stem cells, suggest an embryological basis for the pathogenesis of colorectal cancer (CRC). Thus, the present review article summarizes the diverse roles of these molecular factors in intestinal embryogenesis and related disorders.
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Affiliation(s)
- Antonios Kostouros
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion
| | - Ioannis Koliarakis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki
| | | | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71409 Heraklion, Greece
| | - John Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion
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Abstract
INTRODUCTION Duplications of the alimentary tract are a rare congenital malformation. Most of the cases are symptomatic and diagnosed before 2 years of age. Here, we report a young female presented with a huge abdominal mass, and colonic duplication was confirmed during laparotomy. CASE PRESENTATION A 29-year-old female had chronic constipation treated with laxative agents. She presented to the emergency room with abdominal cramping for 3 days, accompanied with intermittent fever and vomiting. A huge movable abdominal mass was noted during physical examination. Computerized tomography showed a long segmental dilated bowel lumen with stool impaction and bowel wall thickening of the dilated lumen in the left abdomen, highly suggestive of a long tubular colon duplication. The patient underwent subtotal colectomy. Specimen subsequently confirmed the diagnosis for colonic duplication from cecum to sigmoid colon, and the duplicated colon was found on the antimesenteric side of the native colon. She had a stable postoperative course and was discharged 9 days later. DISCUSSION Duplications of the alimentary tract are a rare congenital anomaly. Colonic duplication is an even more unusual malformation of this type. It can be classified into cystic or tubular type according to the gross morphology and may or may not be associated with other congenital anomalies. Most common presentation includes abdominal distention, refractory constipation, and bowel obstruction like many other colorectal conditions. Thus, its indistinct symptoms make it difficult to be diagnosed preoperatively. The recommended treatment is surgical resection of the duplicated lumen along with the attached native colon.
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Sotoodehnia S, Azizi R, Darabi ME, Moazzami B, Jesmi F, Sheikhvatan M. Congenital Tubular Duplication of Colon in an Adult Presented by Abdominal Pain and Constipation: A Case Report and Review of the Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018; In Press. [DOI: 10.5812/ircmj.84205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
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Asour A, Kim HK, Arya S, Hepworth C. Tubular sigmoid duplication in an adult man: an interesting incidental finding. BMJ Case Rep 2017; 2017:bcr-2017-219474. [PMID: 29133579 PMCID: PMC5695356 DOI: 10.1136/bcr-2017-219474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 12/12/2022] Open
Abstract
A 61-year-old man attended an outpatient colorectal clinic for a chronic, non-specific abdominal pain, associated with rectal bleeding. He underwent a number of investigations including a CT pneumocolon, which revealed an incidental finding of 20 cm of additional sigmoid colon. This case is interesting because tubular sigmoid duplication is an extremely unusual condition, rarely diagnosed in adults; only a few cases have been reported of this condition in the adult population. Our team chose to treat this patient conservatively, in order to avoid putting the patient at risk of an unnecessary surgery.
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Affiliation(s)
- Amani Asour
- Colorectal Surgery, BHR University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Hyun-Kyung Kim
- Colorectal Surgery, BHR University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Shobhit Arya
- Colorectal Surgery, BHR University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Clive Hepworth
- Colorectal Surgery, BHR University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
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Nigri G, Petrucciani N, Giannini G, Aurello P, Magistri P, Gasparrini M, Ramacciato G. Giant colonic diverticulum, clinical presentation, diagnosis and treatment: Systematic review of 166 cases. World J Gastroenterol 2015; 21:360-368. [PMID: 25574112 PMCID: PMC4284356 DOI: 10.3748/wjg.v21.i1.360] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/19/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical presentation, diagnosis, and treatment of giant colonic diverticulum (GCD, by means of a complete and updated literature review). GCD is a rare manifestation of diverticular disease of the colon. Less than 200 studies on GCD were published in the literature, predominantly case reports or small patient series.
METHODS: A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. The following MESH search headings were used: “giant colonic diverticulum”; “giant sigmoid diverticulum”. The “related articles” function was used to broaden the search, and all of the abstracts, studies, and citations were reviewed by two authors. The following outcomes were of interest: the disease and patient characteristics, study design, indications for surgery, type of operation, and post-operative outcomes. Additionally, a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD. A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.
RESULTS: In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann’s procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%. An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null, morbidity was very low (1 patient was hospitalized in the intensive care unit for postoperative hypotension), and the patients were discharged 4-14 d after surgery.
CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases. Surgical treatment, consisting predominantly of colonic resection with en bloc resection of the diverticulum, is the preferred option for GCD and guarantees excellent results.
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