Duplication of the cecum and appendix; report of a case.

Abstract

Areview of the literature discloses reports of 9 cases of cecal duplication in adults. Lotheissen (8) reported an example in a 21-year-old female. Evans (3) described a case in a 29-year-old male with intermittent griping lower abdominal pains and a mass in the right lower quadrant. Hughes-Jones (4), reviewing 55 enterogenous cysts of the gastrointestinal tract, found 4 involving the cecum; in adults :21,21,23, and 29 years of age, respectively. Kunath et al. (5) reported a case in a 63-year-old man with attacks of shifting :gaseous distress accompanied by diarrhea. Patterson's patient was a 19-year-old male with right lower quadrant pain and constipation (9). Consiglio (2) observed an example in an aged patient with ileocecotransverse colon invagination led by a cecal enterocystoma. Ladd and Gross (6) define duplications as “spherical or tubular structures which possess a well developed smooth muscle layer and are lined by mucous membrane; they are found at any level from the tongue to the anus, usually intimately attached to some portion of the alimentary tract.” The term is synonymous with “enteric cyst,” “enterogenous cyst,” “inclusion cyst,” etc. Duplications share a common blood supply with the intestinal tract. Because of their congenital origin, they usually become symptomatic early in life, and are discovered in infancy or childhood. The embryologic theories of Bremer (1), Lewis and Thyng (7), and others are adequately covered elsewhere and will not be reviewed here. Report of a Case A 44-year·old Negro woman was admitted to the hospital because of epigastric pain and fresh rectal bleeding of three days duration. She had lost 23 pounds since a similar episode one month previously. A year earlier the patient had experienced several days of diarrhea accompanied by the passage of bright red blood. Physical examination disclosed a small movable mass in the right lower quadrant of the abdomen. A barium enema study showed a persistent filling defect along the medial border of the cecum (Fig. 1). Reflux into the terminal ileum could not be obtained. Barium administered orally outlined the cecum and the appendiceal lumen on the twenty-four-hour film (Fig. 2). Thus antegrade filling failed to show the defect demonstrated by retrograde studies. Because of the possibility of cecal cancer, the intestinal tract was resected from the terminal ileum to mid-ascending colon. Examination of the specimen (Fig. 3) disclosed a congenital duplication of the cecum and appendix.