A case of small-bowel and colon malformation identified during endoscopy in an adult patient

A 57-year-old woman who had never undergone surgery previously was hospitalized due to a 6-month history of intermittent abdominal pain. Computed tomography revealed a communication between a portion of the small intestine and the adjacent segment of the sigmoid colon, with lumen dilatation and localized air and fluid accumulation ([Fig. 1]).

Fig. 1 Computed tomography revealed a communication (arrow) between a portion of the small intestine and the adjacent segment of the sigmoid colon, with lumen dilatation and localized air and fluid accumulation.

The patient underwent gastroenteroscopy. Surprisingly, during colonoscopy, a fistula was observed 22 cm from the anus ([Fig. 2]). After passing the scope through the fistula, three small intestinal lumens were detected ([Video 1]), and a flat polyp measuring 1.2 × 0.8 cm in diameter was observed ([Fig. 3]); therefore, a biopsy was performed. Attempts were made to explore the remainder of one of the small intestines up to 30 cm from the anus, but the blind end was not observed; similarly, resistance was encountered in the remaining two small intestines, preventing further advancement.

Fig. 2 During colonoscopy, a fistula was observed 22 cm from the anus.

A case of small-bowel and colon malformation identified during endoscopy.Video 1

Fig. 3 A flat polyp measuring 1.2×0.8 cm in diameter was observed.

Postoperative pathology indicated tubular adenoma with low grade intraepithelial neoplasia of the small intestine ([Fig. 4]). The patient underwent small-bowel imaging after 1 day, which revealed a partial small-bowel dilatation ([Fig. 5]). She refused surgical treatment and was discharged after being administered conservative treatment such as acid suppression and spasmolysis. Based on the abovementioned findings, the patient was diagnosed with malformation of the small bowel and colon, as well as tubular adenoma with low grade intraepithelial neoplasia.

Fig. 4 Microscopic examination: tubular glandular hyperplasia with mild atypia of adenoma cells (magnification ×10).

Fig. 5 Small-bowel imaging revealed a partial small-bowel dilatation.

Gastrointestinal duplication is a rare congenital malformation that can involve any part of the gastrointestinal tract [1]. It prevalently occurs during infancy and childhood, and is rare in adults [2]. The clinical symptoms of adult gastrointestinal duplication are usually atypical, and imaging examinations are of limited diagnostic value. Generally, most of these malformations are diagnosed via surgical exploration, and only a few can be diagnosed by endoscopy [3] [4]. Herein, we report a rare case of small-bowel duplication and colonic malformation in an adult, combined with tubular adenoma with low grade intraepithelial neoplasia, which provides experience for clinical workers to rationally apply auxiliary means of examination to avoid misdiagnosis.

Endoscopy_UCTN_Code_TTT_1AO_2AB

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Odofin O, Yianni L, Al-Talibi A. et al. Perforation of an ileal duplication presenting as an acute abdomen. Surgeon 2010; 8: 117-118
• 2 Stefanidis K, Lappas I, Kolofousi C. et al. A rare presentation of colonic duplication cyst: report of a case and review of literature. JBR-BTR 2012; 95: 71-73
• 3 Huang ZH, Wan ZH, Vikash V. et al. Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin. Sao Paulo Med J 2018; 136: 89-93
• 4 Jeziorczak PM, Warner BW. Enteric duplication. Clin Colon Rectal Surg 2018; 31: 127-131

Publication History

Article published online:
08 December 2023