Tubular colonic duplication and intestinal malrotation in a child: A case report

Abstract

Introduction

Pediatric colonic duplication is a rare entity that has a wide range of clinical presentations. It is rarely associated with other congenital malformations.

Case presentation

A 2-year-old girl presented to the emergency department with a five-day history of obstipation, vomiting, and worsening abdominal distension. She had a history of chronic constipation. She was found to have an elevated white blood cell count and C-reactive protein. Abdominal plain films and computed tomography findings were suggestive of a large bowel obstruction and included a mesenteric swirl sign concerning for an intestinal volvulus. The patient was taken to the operating room for an emergent exploratory laparotomy. The colon was noted to be significantly dilated. We found an additional loop of bowel coming off from the cecum. This was a tubular duplication, two feet in length, that was also dilated. The duplication had its own mesentery and blood supply coming off the ileocolic pedicle. The site of the colonic obstruction was in the transverse colon, caused by an adhesive band. We performed an extended right hemicolectomy as the colon appeared unhealthy and we suspected that the duplicated colonic segment could have contributed to the patient's symptoms and could be at risk of volvulus in the future. The duplicated colonic segment was resected with the normal colon. We then examined the small bowel and found that it was malrotated, so we did a Ladd procedure. The patient recovered uneventfully and was discharged six days later. She continues to do well, and her chronic constipation has resolved.

Conclusion

Colonic duplications must be included in the differential diagnosis of children who develop chronic constipation and/or acute intestinal obstruction. Patients who have colonic duplications should be studied to rule out other intestinal anomalies such as intestinal malrotation.