1. Colonic duplication in adult: Case Report and Literature Review
成人結腸複製異常：病歷報告及文獻回顧
鄭功全 李克釗 陳鴻華
高雄長庚紀念醫院

2. Brief History Patient’s Profile:
29-year-old female
No known systemic disease
Constipation treated with laxatives for 7 years
Presented to ER for periumibilical pain 3 days
Associated S/S: fever, chills, vomiting
Physical examination and lab data
Huge, movable, non-tender mass at at LUQ
CBC and biochemistry were within normal range except elevated CRP (175mg/dL)

3. Lower GI Series (9 years go, 19 y/o)

4. Abdominal CT

5. Abdominal CT

6. D N Operation: subtotal colectomy with ileosigmoidostomy
Pathologic diagnosis: colonic duplication D N

7. Pathologic findings:
Duplication of colon from appendix, cecum to D-colon with a blind-end. Mucosal necrosis and chronic inflammatory change
Huge ostinum at T-colon.
Thin fibrous septa lined by colonic mucoa at both side

9. Discussion Duplication of alimentary tract is defined as:
a microscopic structure resemble to normal bowel, having mucosa, muscle layers, and serosa
lining with a mucosa similar to some portion of the alimentary tract
those lesions which are contiguous with some portion of the intestinal tract

10. Duplications can be classified as:
Cystic type: 80% of cases
Tubular type: less than 20% - Usually concurrent with urogenital anomalies
Pathogenesis is not clear
Several theories have been proposed. - none of each can solely explain.
Suggest duplications is a multifactorial disease

11. Most patients are diagnosed within 2 y/o
Most common symptom is intestinal obstruction - due to compression of native colon by blind-end
Other s/s: constipation, vomiting, volvulus, perforation
Some cases may be undiagnosed until their adulthood
Because of indolent and vague abdominal symptoms
If without associated malformations, most adult patients remain undiagnosed until complications developed

12. Diagnosis Best established by abdominal CT
Colonoscopy is not helpful unless the ostinum between duplication and naive lumen is large enough to be detected
Difficult to diagnose preoperatively - only 1/7 was diagnosed preoperatively in a case study

13. Prognosis is good owing to benign nature of disease
Treatment
Symptomatic: - En-bloc resection together with the normal colon - Duplicated colon always shares the same mesentaric blood supply with normal colon.
Asymptomatic: - The management is not well-established. - Some may suggest resection to prevent further complications and malignant change.
Prognosis is good owing to benign nature of disease

14. Reference
Al-Jaroof, A. H., Al-Zayer, F., & Meshikhes, A.-W. N. (2014). A case of sigmoid colon duplication in an adult woman. BMJ Case Reports, 2014, 1–4.
Castejón-Casado, J., Muñoz Miguelsanz, M., Diaz, Em., Gomez, Mg., Padilla Garcia, M., & Valade, Rf. (2014). Acute abdomen secondary to complete tubular colonic duplication. Journal of Indian Association of Pediatric Surgeons, 19(3), 166.
Fotiadis, C., Genetzakis, M., Papandreou, I., Misiakos, E. P., Agapitos, E., & Zografos, G. C. (2005). Colonic duplication in adults: Report of two cases presenting with rectal bleeding. World Journal of Gastroenterology, 11(32), 5072–5074.
GROSS, R. E., HOLCOMB, G. W., & FARBER, S. (1952). Duplications of the alimentary tract. Pediatrics, 9(4), 448–68.
Kekez, T., Augustin, G., Hrstic, I., Smud, D., Majerovic, M., Jelincic, Z., & Kinda, E. (2008). Colonic duplication in an adult who presented with chronic constipation attributed to hypothyroidism. World Journal of Gastroenterology, 14(4), 644–646.
Kyo, K., Azuma, M., Okamoto, K., Nishiyama, M., Shimamura, T., Maema, A., … Yokoyama, H. (2016). Laparoscopic resection of adult colon duplication causing intussusception. World Journal of Gastroenterology, 22(7), 2398–2402.