65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Duplicated descending colon as a cause of chronic constipation: A rare case and review of the literature
M. Muradbegovic1, I. Labgaa1, 2, S. Andrejevic-Blant3, L. Di Mare1, D. Petermann1, Presenter: M. Muradbegovic1 (1Morges, 2Lausanne, 3Epalinges)
To report a case of chronic constipation due to descending colon duplication.
A 40-years-old woman was referred to our division for management of a pelvic cyst discovered in the context of severe chronic constipation with only moderate abdominal pain. Physical examination showed mild abdominal distension with a palpable suprapubic mass but no tenderness. Biological tests were unremarkable. An abdominal CT-scan pointed a fecaloma of 9x11cm and the presence of a right pelvic cystic mass measuring 7x7x12cm. A colonoscopy was inconclusive because of the of low-quality preparation due to constipations. An abdominal MRI confirmed the cystic nature of the lesion, evoking a benign tumor. Because of the importance and long-time persistence of the symptoms, a diagnostic laparoscopy was performed.
The diagnostic laparoscopy revealed an en-Y duplication of descending colon which originated distally to the splenic flexure. The duplicated colon presented as a 30 cm blinded tube with a cyst at its end. A segmental resection of the duplicata was proceeded with sparing of the colonic meso shared by both the native and the duplicated colon. We re-established bowel continuity with an extracorporeal end-to-end hand sewn anastomosis. Histopathological finding confirmed the diagnosis of duplicated colon showing a mixed cystic and tubular pattern but no malignancy. At 30 day follow up the patient was free of complication and the transit was normal without constipation. Gastrointestinal duplication is a rare congenital anomaly mostly detected during childhood but uncommonly in adults. Colon is rarely affected, particularly descending colon. In the literature, there are 50 cases reported during the last 20 years with only 3 cases concerning the descending colon. There is two separated pattern concerning the intestinal duplications. It can be either cystic (80%) or tubular, but very rarely mix of these two patterns is found. Associated symptoms are unspecific. The preoperative diagnostic constitute a challenge and definitive diagnosis is made intraoperatively. Surgical resection of a duplicated gastrointestinal tract should be attempted to prevent future complications including the risk of adenocarcinoma.
Chronic constipation associated with an abdominal cystic mass can correspond to a colonic duplication. Mixed cystic and tubular form of intestinal duplication is very rare.