Total colonic tubular duplication causing severe constipation

Abstract

Aim: To report the case of a patient with total colonic tubular duplication pointing out the diagnostic and therapeutic difficulties and reviewing the Literature concerning this rare malformation. Case report: The patient was a female girl born at term with vertebral and spinal anomalies. At 6 months she underwent emergent left upper lobectomy for a symptomatic, previously undiagnosed left congenital lobar emphysema. She also had intractable coprostasis and abdominal distension. The clinical picture and the results of the contrast enema made us think of congenital megacolon but suction rectal biopsies were inconclusive. Therefore we obtained full thickness colonic and terminal ileum biopsies and we performed an ileostomy for faecal diversion and bowel management. A few months later, the anterograde contrast study from the distal ileostomy showed two colons with proximal communication and a distal pouch. On laparotomy, we confirmed the diagnosis of complete colonic tubular duplication. We divided the common wall between the two colons, we performed a mucosectomy and we removed the duplicated segment. Post-operative course was uneventful. Conclusions: Duplications of the colon are rare and the diagnosis is not easy. Two main problems occurred during surgery: differentiating between normal and duplicated colon and removing the duplication avoiding extensive colonic resections. Resection of the common wall, mucosectomy and removal of the duplicated colon represented a feasible and safe procedure. Keywords: Colon duplication, Constipation, Paediatric surgery, Congenital malformation