Complete tubular duplication of colon in an adult: a rare cause of colovaginal fistula

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Abstract

Alimentary tract duplications are uncommon congenital anomalies that usually present during the first decade of life. Complete duplication of the colon in adults is very rare and difficult to diagnose preoperatively. We report a case of a 40-year-old female with complete tubular duplication which was initially misdiagnosed as a salpingeal abscess due to colovaginal fistula.

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Surgical management of alimentary tract duplications.

Tyler J O’Neill, H Bishop, A Gheissari … (1989)

Alimentary tract duplications are unusual anomalies that may require surgical intervention in the neonate, infant, and occasionally in the older child. The clinical presentation of patients with alimentary tract duplications includes bleeding, abdominal pain, intussusception, and respiratory distress, or it may be an incidental finding on either abdominal examination or chest x-ray. A review of 96 patients with 101 duplications seen over the last 37 years is reported herein. Twenty-one duplications were confined to the thorax; three were thoracoabdominal, and 77 were abdominal. Seventy-four patients presented as infants less than 2 years of age, and 22 patients were older. Ectopic gastric mucosa was found in 21 duplications, and pancreatic tissue was found in five. Seventy-five duplications were cystic and 26 were tubular. Ultrasonography, computed tomography (CT), and myelography are helpful diagnostic tools. Ninety-four of the 96 patients underwent surgical management for their duplications. One duplication was found at necropsy, and one patient was asymptomatic and did not undergo operation. A single death occurred in a 2-day-old infant who had intrauterine volvulus and meconium peritonitis. Management was based on the age and condition of the patient, the location of the lesion, whether it was cystic or tubular and communicating with the true intestinal lumen, and whether it involved one or more anatomic locations. Generally, total excision was preferred, but staged approaches were sometimes necessary.

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Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations.

David Tollerud, Carolyn Weiss, Patricia McGowan … (1988)

Duplications of the alimentary tract are unusual congenital anomalies that frequently present a diagnostic as well as therapeutic challenge to the surgeon. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. Due to the complicated anatomy and common blood supply shared between the duplication and associated native bowel, appropriate management requires a familiarity with the anatomy and clinical characteristics of this entity. To better define the range of patient characteristics, clinical presentation, and preferred therapy, 20 enteric duplications were reviewed in 17 patients treated at the Children's Hospital Medical Center from 1956 to 1986. Ages of patients ranged from 1 day to 11 years; 60% were less than 2 years of age at initial presentation. Seven duplications in six patients involved alimentary tract structures of foregut derivation (esophagus, stomach, and Parts I and II of duodenum), with a predominance of girls (4 of 6). Most of these patients (67%) presented with moderate to severe acute respiratory distress and a mass present on chest radiograph. In 67% of the patients, the correct diagnosis was established before operation. None required emergency operative intervention. By contrast, 13 duplications in 11 patients were of midgut or hindgut derivation (Parts III and IV of the duodenum, jejunum, ileum, and colon). In this group of patients, 62% of the duplications involved the cecum, 23% involved the ileum, and 16%, the jejunum. Seventy-eight per cent of the patients were boys. The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Emergency operative intervention was required of eight of 11 patients with duplications involving the small bowel and colon. Three patients presented with an intussusception, four with signs and symptoms consistent with acute appendicitis, one with a small bowel obstruction, and two with gastrointestinal hemorrhage due to the presence of ectopic gastric mucosa within the duplication. It was found that two important points must be considered in regard to the management of enteric duplications: (1) the common blood supply shared between the duplication and native bowel must be carefully protected to avoid undue sacrifice of normal bowel, and (2) the presence of heterotopic gastric mucosa in 35% of patients negates internal drainage.(ABSTRACT TRUNCATED AT 400 WORDS)

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Duplication of the transverse colon in an adult: case report and review.

Filippo Banchini, Rocco Delfanti, Evelina Begnini … (2013)

Tubular duplication of the colon is very rare especially in adulthood, because it is frequently symptomatic earlier in newborn life, so only few cases are reported in literature. Several theories are proposed to explain the onset and the evolution of gut malformations as the aberrant lumen recanalization or the diverticular theory, the alteration of the lateral closure of the embryonal disk or finally the dorsal protrusion of the yolk-sac for herniation or adhesion to the ectoderm for an abnormality of the longitudinal line, but none clarifies the exact genesis of duplication. We present a case of "Y-shaped" tubular duplication of the transverse colon in a 21-year-old adult, with a history of chronic pain and constipation, referred to our department for abdominal pain with retrosternal irradiation, treated with the resection of the aberrant bowel.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Surg Treat Res

Journal ID (iso-abbrev): Ann Surg Treat Res

Journal ID (publisher-id): ASTR

Title: Annals of Surgical Treatment and Research

Publisher: The Korean Surgical Society

ISSN (Print): 2288-6575

ISSN (Electronic): 2288-6796

Publication date (Print): October 2016

Publication date (Electronic): 30 September 2016

Volume: 91

Issue: 4

Pages: 207-211

Affiliations

Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

[1 ]Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

Author notes

Corresponding Author: Sang Ho Bae. Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea. Tel: +82-41-570-3636, Fax: +82-41-571-0129, bestoperator@ 123456schmc.ac.kr

Article

DOI: 10.4174/astr.2016.91.4.207

PMC ID: 5064232

SO-VID: 45b5f3dc-2982-493d-ae53-8f588dfb5b13

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Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 April 2016

Date revision received : 02 June 2016

Date accepted : 10 June 2016

Funding

Funded by: Soonchunhyang University, CrossRef http://dx.doi.org/10.13039/501100002560;

Complete tubular duplication of colon in an adult: a rare cause of colovaginal fistula

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Most cited references 10

Surgical management of alimentary tract duplications.

Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations.

Duplication of the transverse colon in an adult: case report and review.

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