Diagnosis and treatment of a rare small intestine duplication in adult under double-balloon enteroscopy and laparoscopy

A 35-year-old man was admitted to the hospital due to unexplained recurrent abdominal pain and hematochezia for 1 year. Lab results showed mild anemia (HGB 122 g/L). Abdominal enhanced computed tomography showed a blind tube-like structure near the right lower abdomen and ileum. The distal local wall was nodular, thickened, and significantly enhanced ([Fig. 1]). Double-balloon enteroscopy (DBE) was then performed through the oral route and the anal route ([Video 1]). A double lumen opening of the ileum was displayed approximately 1.2 m from the anal route. One irregular semi-circular ulcer with a white coating was found near the stricture in one lumen. It was suspected to be a small intestine duplication anomaly.

Fig. 1 Computed tomography images showed a blind tube-like structure near the right lower abdomen and ileum.

Double-balloon enteroscopy and laparoscopic observation of ileal tubular duplication deformity with independent mesentery and blood supply.Video 1

During laparoscopic exploration ([Video 1]), a lumen approximately 8 × 2 cm in size could be seen at the distal end of the ileum, approximately 30 cm away from the ileocecal region. Its mesentery showed a tubular lumen, which was different from Meckelʼs diverticulum. In particular, this tubular lumen had an independent mesentery and blood supply. Subsequently, we pulled out the ileum and used a cutting stapler to remove the duplicate deformed intestinal segment. The postoperative diagnosis was ileal duplication deformity ([Fig. 2]). Pathology showed that intestinal mucosa contained ectopic gastric glands ([Fig. 3]). The patient was discharged 9 days after surgery and did not experience any particular discomfort.

Fig. 2 Duplicated and deformed small intestine after dissection.

Fig. 3 Pathological result indicated that intestinal mucosa contained ectopic gastric glands.

Intestinal duplication is a rare congenital anomaly that typically occurs during fetal or pediatric development [1] [2]. Duplicated segments usually share a common wall and blood supply with native intestine. Clinical symptoms can manifest as abdominal pain, bloody stools, and even intestinal obstruction. It can easily be misdiagnosed as Meckelʼs diverticulum. For treatment, surgical intervention is required to correct deformities and restore normal function. Previous reports of small intestine duplication mainly occurred in children [1] [3]. Here, we report a rare case of ileal tubular duplication deformity with an independent mesentery and blood supply in an adult male.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Puligandla PS, Nguyen LT, St-Vil D. et al. Gastrointestinal duplications. J Pediatr Surg 2003; 38: 740-744
• 2 Morris G, Kennedy AJ. Small bowel congenital anomalies: a review and update. Surg Clin North Am 2022; 102: 821-835
• 3 Liu J, Yu Y, Ji R. et al. Gastrointestinal bleeding in a child: is it a meckel diverticulum?. Am J Gastroenterol 2023; 118: 399-400

Publication History

Article published online:
29 April 2024