English

Abstract

Duplication of bowel represents one of many congenital abnormalities of the gastrointestinal tract. It is a not uncommon cause of acute abdominal pain but remains a consideration in the pediatric population. It is well known that exploratory laparotomy is undertaken in pediatric patients. But in adults it will be difficult to diagnose this as the cause of chronic abdominal pain. We present the case of a patient who was admitted to hospital several times for recurrent abdominal pain in whom we eventually diagnosed intestinal duplication. KEYWORDS: Bowel duplication, Congenital anomaly. CASE REPORT: A 23-year-old man presented to the emergency department at the District Hospital Belgaum, attached to Belgaum Institute of Medical Sciences, Belgaum with a history of acute onset of cramping per umbilical pain and vomiting. His medical history included multiple admissions over a 6- year period for similar symptoms. Physical examination revealed mild abdominal tenderness but no peritonitis. Soon after admission, his acute abdominal pain resolved. An ultra sonological report of abdomen revealed a multiloculated cystic mass, suggesting a mesenteric cyst. In view of chronic pain in the abdomen, we obtained consent for exploratory laparotomy. The procedure revealed an ileal duplication 38-cm long with a cystic dilatation that had adhesions to the transverse colon (Fig.1). The base of the cyst was fibrotic, suggesting that recurrent obstruction at this level resulted in the patient's periodic episodes of abdominal pain. We resected the cyst and the parallel segment of small bowel and conducted a primary anastomosis. The patient had an uneventful postoperative period. DISCUSSION: Gross and colleagues 1 first defined intestinal duplication as spherical or tubular structures that possess a well-developed smooth muscle layer and are lined with a mucous membrane; they are found at any level from tongue to anus and usually are intimately attached to some portion of the alimentary tube. One large study 2 suggests that most duplications are intra- abdominal and of these, ileal and ileocecal duplications are the most common. Clinical presentation is similar to that in our patient's case and includes recurrent abdominal pain, vomiting, abdominal distension, gastrointestinal hemorrhage and sometimes peritonitis if a peptic ulcer perforation occurs in the duplicated segment with ectopic gastric mucosa or in the adjacent normal bowel. 3,4 The duplication can be the lead point in intussusception2,4 or the site of volvulus.2 Pre-natal ultrasound or ultrasound at the time of clinical presentation may lead to the diagnosis of these benign lesions. Differentiation from mesenteric cysts can sometimes be made during that initial ultrasound based on the thinner nature of the intestinal wall. Preoperative diagnosis is more commonly made with intestinal duplications of foregut than of mid gut or hindgut origin. 4 The universally accepted management of this condition is surgical intervention, and the