Colonic duplication in an adult who presented with chronic constipation attributed to hypothyroidism

Abstract

Gastrointestinal duplications are an uncommon congenital abnormality that manifest before the age of two in 80% of cases. Ileal duplication is the most common while colonic duplication, either cystic or tubular, occurs in 10%-15% of cases and remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults in only a few cases. The most common clinical manifestations are abdominal pain and intestinal obstruction. Rarely, duplications present with signs of acute abdomen or acute bleeding. This study reports a case of colonic duplication in an adult who presented with chronic constipation. Complete diagnostic workup was made on several occasions during the previous eight year period, but no pathology was found and chronic constipation was attributed to hypothyroidism caused by long standing Hashimoto thyroiditis. Multislice CT, performed because of abdominal distension, defined colonic pathology but the definite diagnosis of duplication of the transversal colon was made at operation. The cystic duplication and the adjacent part of the ascending and transversal colon were excised en-block. This study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of chronic constipation even when precipitating factors for constipation, such as hypothyroidism are present.

Feline abdominal ultrasonography: What’s normal? What’s abnormal? The diseased gastrointestinal tract

“…77 Indeed, a search of the human literature reveals occasional reports of patients with enteric duplications and medical histories of chronic constipation (up to 20 years' duration) prior to a correct diagnosis being made. [84][85][86] In both humans and cats, duplication cysts can cause non-specific GI signs such as vomiting due to partial intestinal obstruction following accumulation of secretions within the cyst 80,81,87 and constipation 77 depending on the location of the cyst. In other cases, some cats may be asymptomatic 79,82 and the duplication cysts only identified by the presence of a palpable abdominal mass.…”

Rectal duplication cyst in a cat

“…15 Adults may experience similar symptoms, with acute presentations attributed to recent haemorrhages from ulceration or malignant transformation within the duplication 16,17 ; the oldest reported patient was 82 years old. 19 The age of the affected dogs with large bowel duplication cysts ranged from 9 weeks to 5 years (median 6 months), the described feline was a 2-year-old Manx cat. 13 The present case of acute constipation in an 7-year-old patient with a congenital malformation seems puzzling, but a lifelong history of dyschezia not recognised by the owner beforehand seems most likely.…”

“…Similar reports of patients with enteric duplications and medical histories of chronic constipation lasting up to 20 years before correct diagnosis exist in the human medical literature. 16,18,19 Gradual increase in size of the cystic duplication due to accumulation of mucosal secretions might have lead eventually to the almost complete bowel obstruction through compression, as space within the pelvic canal is restricted.…”

Occult Colonic Duplication

“…6 Some authors recommend that if a duplication is encountered incidentally, it should be removed to avoid any future complications, including the possibility of malignant degeneration. 3,7 Our patient presented with episodes of abdominal distention and diarrhea and we suspected bacterial overgrowth secondary to dysmotility or stricture at the anastomotic site. We did not include duplication in our differential diagnosis because of the negative evaluation in the neonatal period.…”