Rectal duplication in adult presented with constipation: a case report and literature review

Abstract

Background Rectal duplication is a rare congenital disease which is mostly diagnosed during childhood. Diagnosis in adulthood could be obscured as the presenting symptoms including difficult defecation, bloating, and abdominal distension would lead to other diagnosis. Constipation is common in female adult and conservative treatment is usually successful. Refractory constipation requires further work-up. However, rectal duplication is a rare cause of adult constipation. Methods We reported a 42-year-female who presented with chronic constipation which became intractable after total abdominal hysterectomy. Barium enema, CT scan, and colonoscopy revealed an additional rectal pouch connecting to the native rectum containing large fecaloma. Anorectal manometry showed dyssynergic defecation, rectal hyposensitivity but presence of rectoanal inhibitory reflex. Results Transabdominal resection of the rectal duplication pouch and protective colostomy was performed. After a course of biofeedback, the colostomy was reversed. The patient remains healthy at 4 years of follow up. Conclusion Rectal duplication could be a cause of refractory constipation in adulthood. A collection of fecal material via a connection with the native rectum led to a large symptomatic fecaloma.