Colonic Duplication Research Articles

Unusual Recto-colonic Tubular Duplication in a Female Neonate

Complete tubular colonic duplication is exceedingly rare. A second ectopic opening in the perineum other than a normally cited anus could be an unusual presentation. We report an unusual case of recto-colonic duplication in a 16-day-old girl who presented with fecal discharge from a vestibular opening in addition to a normally situated anus. The diagnosis of total recto-colonic tubular duplication associated with a rectovestibular fistula and a normal anus was confirmed by barium enema and computed tomography scan with double contrast. At operation, we performed a long transanal incision of the common septum to create an anastomosis between the normal and duplicated colon with complete submucosal excision of the rectovestibular fistula. The patient was doing well at 3-year follow-up examination.

Surgical treatment for tubular colonic duplication communicating to retroperitoneal space in an adult dog

Surgical treatment for tubular colonic duplication communicating to retroperitoneal space in an adult dog

Congenital Tubular Duplication of Colon in an Adult Presented by Abdominal Pain and Constipation: A Case Report and Review of the Literature

Introduction: Congenital duplications of the intestinal tract are rare diseases, observed mainly in ileum and stomach, while less than 7% of cases occur in the colon. They are mainly diagnosed during early childhood, while few cases may remain asymptomatic until adulthood. Case Report: We present a 31-year-old female with chronic abdominal pain without significant past medical history. Pre-operative diagnosis was an enterocolic fistula, which was considered after colonoscopy. Abdominal surgery with midline incision was performed for the patient with suspicion of congenital colon anomaly. During the surgery, the surgeon found an additional colon closed loop that originated from the posterior aspect of the transverse colon and was attached posteriorly to the sigmoid colon. Microscopic examination revealed tubular duplication of the colon with marked dilatation, focal mucosal ulceration, granulation tissue, and mild chronic nonspecific inflammation. Discussion: As congenital duplication of colon is a rare condition with non-specific clinical symptoms, high suspicion of the physician and thorough examination can help the diagnosis and surgical treatment as soon as possible to stop patients’ pain and associated problems.

Gastroschisis associated with intestinal duplication cyst

Abstract Introduction Gastroschisis is much less frequently associated with anomalies than omphalocele. The most common associated anomaly is gastrointestinal abnormalities. Intestinal atresia is found in 10–15% of cases of gastroschisis. Intestinal duplication is a very rare association. Case report We present a unique case of gastroschisis with an associated intestinal (colonic) duplication cyst in a 4 -day -old 36 weeks pre-term, delivered to a primiparous 16 year old mother, presenting on account of anterior abdominal wall defect with protrusion of bowel through a defect on the right side of the umbilical cord. Examination showed a tubular mass protruding through a 3 cm defect on the right side of the umbilical cord, with a narrow appendix -like appendage at the summit. Laparotomy was done within 24 h of admission. Findings include a protruding tubular mass adherent to the serosa and muscularis layer of the mid transverse colon and the adjacent greater omentum. Mass was excised. Results He did well postoperatively but developed surgical site infection which was managed by daily wound dressing. He was discharged 2weeks post operative and was doing well at last follow up visit. Histopathology confirmed smooth muscle lining of the cyst wall, with interspersed goblet cells within the mucosa. Conclusion This report underscores the importance of thorough examination of content of gastroschisis for prompt diagnosis of rare anomalies like intestinal duplication.

Undetected Duplication Cyst of The Cecum Until Adulthood

Intestinal duplication is a rare congenital anomaly of the digestive tract. It is often diagnosed antenatally or in the first two years of life. It is observed anywhere in the digestive tract, often in ileum and jejunum. We present a rare case of colonic duplication cyst in adult age in this paper. Our case was diagnosed by ultrasonography performed due to the complaint of chronic abdominal pain and was followed up for 18 months. The patient underwent surgery due to strong suspicion of malignancy. During the operation, the cyst was accessed only after palpation and was resected together with the right colon. The definitive diagnosis could be made by pathological examination. Duplication cysts can cause significant morbidity and even mortality if left untreated. For this reason, it is important to recognize this rare congenital anomaly.

A Systematic Review of Prenatally Diagnosed Intra-abdominal Enteric Duplication Cysts.

With improvements in prenatal ultrasound, more abdominal enteric duplication cysts (EDCs) are diagnosed prenatally. The optimal time for operative intervention is unclear. We aimed to review the evidence supporting the indication and timing of surgery for prenatally diagnosed EDCs. A systematic review was performed using a defined search strategy identifying articles with inclusion criteria of prenatal diagnosis of histologically confirmed EDCs. Outcomes included (1) indications for resection (symptoms vs. prophylactic) and (2) time from birth to operative intervention. Of 1,590 articles screened, prenatal diagnosis of histologically confirmed EDCs was made in 68 articles, detailing indications and timing for resection for 86 patients. Thirty-five patients (41%) became symptomatic early and were resected promptly at a median of 2 days of age. Indications for intervention included bowel obstruction, volvulus, bleeding, recurrent pain and diagnostic dilemma (concern for cystic neuroblastoma). There were 51 patients (59%) who were resected prophylactically at a median of 90 days of age without interval symptoms. Symptomatic cysts had a larger mean cyst diameter. There was a difference in the anatomic distribution of asymptomatic or symptomatic EDCs-gastric duplications were more frequently asymptomatic while jejunal, proximal ileal and colonic duplications were more frequently symptomatic. The optimal approach to EDCs diagnosed prenatally is not supported by strong evidence in the literature. Our systematic review indicates that almost half of the infants diagnosed prenatally become symptomatic early and are resected. In asymptomatic patients, close observation and delayed prophylactic resection in infancy can be considered.

重複膣・子宮を有し，鎖肛を伴わない直腸膣瘻を合併した管状型回腸・全結腸重複症の1女児例

重複膣・子宮を有し，鎖肛を伴わない直腸膣瘻を合併した管状型回腸・全結腸重複症の1女児例

Transitional Cell Carcinoma Arising in a Duplication of the Colon: A Case Report

Background: Duplications of the gastrointestinal tract are many and variable, the most common sites being in the esophagus and ileum. The colon is infrequently involved. Even less frequent is malignant change in these anomalies. This paper reports a case of Primary transitional cell carcinoma (TCC) arising in a duplicated colon. Transitional cell carcinoma (TCC) arising in a duplicated colon is rare. We report a case of 61 years old male presented by epigastric swelling. Computarized tomography (CT) revealed the presence of cystic mass related to transverse colon. At surgery a firm perforated cystic mass with mural component connected to transverse colon was noted. Methods: The mass was completely excised and gross examination revealed rounded cystic mass measuring 15x15 x3 cm in diameter attached to colon. Microscopic evaluation and immunohistochemistry study were performed. Results: The mass was diagnosed as high grade TCC developed in duplicated colon and infiltrate the attached colonic wall. Conclusion: To our knowledge, this is the first reported case of “pure” TCC arising in a duplication of the colon.

Endoscopic Treatment of Colonic Duplication Cyst

Introduction: Colonic duplication cyst is a rare congenital abnormality commonly presenting before age of 2 years. We here present a case of endoscopic ultrasound (EUS) guided diagnosis and treatment of colonic duplication cyst. Case report: A 42-year-old African-American female underwent colonoscopy for evaluation of constipation. She denied any associated history of anorexia, weight loss or hematochezia. Her colonoscopy showed a large submucosal lesion at the hepatic flexure. The lesion was tattooed by India ink and the patient was referred to advance endoscopist for further evaluation. Meanwhile her CT scan of abdomen with contrast was done which was showed a small cystic lesion around splenic flexure. On repeat Colonoscopy with endoscopic ultrasound (EUS), a tattooed subepithelial lesion was seen in the hepatic flexure (Figure 1). On EUS, a 14 mm anechoic lesion lined by mucosa consistent with duplication cyst was seen (Figure 2). The mucosa was then snared exposing the cyst (Figure 3). The patient was discharged home with outpatient follow-up. Pathologic evaluation showed normal colonic mucosa without any dysplastic changes.Figure: Intraluminal mass at hepatic flexure (A) and transparent appearance (B).Figure. 12: MHz EUS images showing subepithelial anechoic lesion lined by mucosa.Figure: Fluid drainage after unroofing the cyst cavity (A) and flattening of lesion after drainage (B).Discussion: Enteric duplication cysts are rare entity encountered in pediatric age group and extremely rare in adults. Most common site of enteric duplication cyst is Ileum followed by ileocecal valve with colonic duplication cyst comprising only 6.8% in one case series. These cysts commonly occur on the mesenteric side of bowel and share a common blood supply with native bowel. The clinical presentation varies in patients ranging from abdominal pain, volvulus, intussusception, ischemic bowel, obstruction, and constipation. CT scan and US abdomen are helpful in making the diagnosis of duplication cyst. US may reveal fluid filled complex cyst with internal echoes. They are also characterized by typical inner echogenic mucosa and outer hypoechoic muscle layer. Cases of malignant transformation have rarely been reported in literature including one case of the metastatic disease. Surgical resection is classically being done for the cyst as they are found incidentally or intraoperatively. Effective drainage was established by hot snare resulting in resolution of patient's symptoms. Duodenal duplication cysts have been effectively drained and treated endoscopically commonly using needle knife papillotomy with good reported long-term outcomes. This case is the first reported case of EUS guided drainage of colonic duplication cyst.

Cystic Duplication Cyst of Ascending Colon in an Adult

ABSTRACTGastrointestinal duplication cysts are rare congenital abnormalities that are usually seen in childhood. Colonic duplication cyst is very rare in adults and is usually asymptomatic. We report a 42‑year‑old female with a duplication cyst in the proximal ascending colon who presented with recurrent episodes of colicky abdominal pain. The cyst could be well visualized on colonoscopy and the patient underwent successful right hemicolectomy with ileotransverse anastomosis.

Volvulus U-Shaped transverse colonic duplication: Report of a case and literature review

Abstract 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 [1–3]. U Shaped transverse colonic duplication with volvulus has never been reported before and very rare in condition in gastrointestinal duplication.

Gastrointestinal Duplication Presenting as Neonatal Intestinal Obstruction: An Experience of 15 Years at Tertiary Care Centre.

Background: Gastrointestinal tract (GIT) duplications are one of the rare congenital anomalies and can occur in any portion of the gastrointestinal tract but are more commonly encountered in small intestine. The duplication cysts cause symptoms like abdominal mass and intestinal obstruction requiring surgery or may remain asymptomatic. We are reporting our 15 years’ experience duplication cysts presenting in neonates. Methods: It is a retrospective study undertaken in the department of pediatric surgery between 2001 and 2015 for GIT duplications in neonates. Patients were analyzed for their antenatal diagnosis, age, sex, clinical diagnosis, investigatory approach, operative management and surgical outcomes. Results: Total number of neonates, diagnosed with gastrointestinal duplication in the last 15 years, was 17. Male to female ratio was 3.3:1. The most common location was found to be the ileum occurring in 71% of cases. Apart from ileum, 2 cases of duodenal and 1 case each of gastric, colonic and cecal duplication cyst were encountered. Majority cases presented with sub-acute intestinal obstruction and were managed successfully by resection and end to end anastomosis. Associated gut atresia was found in 4 cases while 1 case was found to be associated with perforation of gut. Conclusion: Gastrointestinal tract duplications often present with typical symptoms of gastrointestinal tract obstruction. Early diagnosis and management is required to prevent postoperative morbidity and mortality.

Colonic Atresia: Association with Other Anomalies.

Background: Colonic atresia (CA) is a rare form of congenital intestinal atresia. Although CA may be isolated, it is more commonly reported in literature in association with other congenital anomalies. Materials and Methods: This study is a review of prospectively collected data of all the patients with colonic atresia presented to our center (Ain Shams University) during 2008 to 2016. Results: Twelve patients were enrolled in this study. The atresia was of type I in one case, type II in four cases, type IIIa in six cases, type IV in one case. These cases accounted for 4.9 % of intestinal atresias managed in our center during the same period. Five cases were isolated CA, while the other seven cases had associated abdominal congenital anomalies (exomphalos, Hirschsprung's disease, imperforate anus, closing gastroschisis, colonic duplication, and multiple small bowel atresia in two cases). The management in ten cases was by staged procedure with creation of a temporary stoma initially, while primary anastomosis was established in two cases. We had two cases with delayed presentations, one missed diagnosis, and three mortalities in this series. Conclusions: The low incidence of CA may result in delay in the diagnosis and management. Hirschsprung's disease should be excluded in every case of colonic atresia. Early diagnosis and proper surgical management is essential for good prognosis.

Retroperitoneal Peripancreatic Colonic Duplication Cyst Can Mimic Mucinous Cystic Neoplasm of Pancreas on Fine Needle Aspiration Cytology

Retroperitoneal Peripancreatic Colonic Duplication Cyst Can Mimic Mucinous Cystic Neoplasm of Pancreas on Fine Needle Aspiration Cytology

Anorectal Malformation with Colonic Duplication and Dual Rectovaginal Fistulae

Anorectal malformations associated with colonic duplications are rare. We report a case of imperforate anus, tubular colorectal duplication, and dual rectovaginal fistulae. This case illustrates the diagnostic challenge and variable presentation of colonic duplications and the use of laparoscopy in the surgical management. A review of the etiology, presentation, and surgical therapy is presented.

術前診断が困難であった成人結腸重複症に対して腹腔鏡補助下に摘出した１例

症例は66歳，男性．近医で胸部異常陰影を指摘され当院に紹介された．胸部単純CTで横行結腸間膜に腫瘤を認めたため精査の方針となった．腹部造影CTでは横行結腸間膜に３cm大の造影効果の乏しい石灰化を伴う囊胞性腫瘤を認め，中結腸動脈に近接していた．GISTや神経鞘腫を鑑別に挙げたがいずれも決定的ではなく，横行結腸間膜腫瘍の診断にて腹腔鏡補助下腫瘍摘出術を施行した．鏡視下で右側結腸を授動した後，小開腹創をおき腫瘍を確認し，腫瘍の流入血管を切離し摘出した．肉眼的に摘出検体は最大径39mmの囊胞状腫瘤であった．病理組織学的に腫瘍の囊胞壁に大腸粘膜上皮と平滑筋層を含む大腸成分を認めたが，本来の大腸との連続性を認めず，球状型・非交通性の横行結腸重複症と診断された．大腸重複腸管は比較的稀であり，術前診断は困難とされている．また近年では腹腔鏡下手術の症例報告も認められ，文献的考察を含めて報告する．

Laparoscopic excision of an ascending colon duplication cyst in an adolescent

Abstract Colonic intestinal duplications are infrequent and rarely present past early childhood. We present the case of a large, ascending colon duplication in a 17-year-old boy resected using minimally invasive techniques. This appears to be the first reported case of a laparoscopic en-bloc ascending colon duplication resection in an adolescent. The diagnosis and management of colonic duplications are discussed.

Duplication colique découverte à l’occasion d’une occlusion intestinale par fécalome

Colonic duplications are very rare in children. With rectal duplications, they are the rarest locations of alimentary tract duplications, most often diagnosed in the first years of life. We report an unusual case of colic duplication with fecal impaction in a 9-month-old boy revealed by intestinal obstruction. We discuss the main diagnostic and therapeutic aspects of this malformation.

Tubular duplication of colon and terminal ileum in a female child, case report, review of literature and proposal of a new classification

Abstract A case of a four and a half years old girl with total colon and terminal ileal duplication with a normally situated anus, vestibular fistula, double bladder and urethra with a unique feature of loop duplication of terminal ileum and part of the colon is reported. A proposal is made for a new simplified classification.

English

Colonic duplication cysts are rare entities. Clinical presentation depends upon the location, size and the presence of heterotropic gastric mucosa. We present a case of Transverse colon duplication cyst presenting as a subhepatic cystic lesion which was treated successfully.