“Total tubular colonic triplication with recto-vestibular fistula and normal anus: A case report”

Abstract

Introduction: Colonic triplication in a tubular form is one of the rarest types of congenital malformations of the digestive system, with only 10 cases reported in the literature. Case presentation: a 2-day-old female newborn with abdominal distension, a vestibular protrusion, having failed to pass meconium presented to the surgery clinic. The vestibular protrusion was opened, and drained meconium. With the diagnosis of an anorectal malformation, the patient underwent a colostomy. At the time of the colostomy, multiple lumens were found, which was suspicious for a colonic triplication. At 6 months of age, she underwent a laparotomy during which a colonic triplication was confirmed. One of the lumens started at the cecum, connected to the terminal ileum and ended as a vestibular fistula, the second lumen started at the cecum without a connection to the small bowel and ended in an otherwise normal anus. The third lumen started at the cecum, not connected to the small bowel, and ended blindly in the rectosigmoid region. We reconstructed the intestinal transit by disconnecting the vestibular fistula and anastomosing the proximal opening to the colonic lumen that ended on the normal anus. Following that, during a separate procedure, we resected the two redundant duplications and closed the colostomy. She was doing well at the time of the last follow up, four months after the colostomy closure. Conclusion: Colonic triplication is an extremely rare congenital malformation. It can be associated with additional anomalies such as anorectal malformations, as in this case. A proper repair requires a complete understanding of the pathway of each of the lumens.

Keywords

• Rectovestibular fistula
• Colonic triplication
• Case report