Diagnosis of rare tubular duplication small bowel malformation in adult woman by enteroscopy

Gastrointestinal duplication is rare, affecting males (78%) more than females [1]. The ileum is the most common site, accounting for over 60% of cases [2]. Duplications are mainly cystic (86%) or tubular [3].

A 26-year-old woman with no medical history presented with intermittent abdominal pain. A previous colonoscopy suggested an ileocecal diverticulum. An abdominal computed tomography (CT) showed no issues ([Fig. 1]). Small intestine CT showed no significant changes ([Fig. 2]). We decided to perform a second colonoscopy and found an enteric structure with a double lumen next to the appendix opening ([Fig. 3]).

Fig. 1 Abdominal enhanced computed tomography (CT), suggesting an irregular cystic low-density shadow on the right side of the pelvis.

Fig. 2 Small bowel CT enhancement, suggesting an irregular cystic lesion on the right side of the uterus, with no significant enhancement observed on enhanced scanning.

Fig. 3 Endoscopic image showing a double-lumen small intestine.

To elucidate the anatomy, a small bowel endoscopy was performed, identifying a 3-cm ileocecal fistula with two distinct lumina mimicking small intestinal mucosa. Further exploration via the fistula exposed colonic mucosa. After retracting the endoscope and advancing it 20 cm into the small intestine, no abnormalities were observed. Titanium clips were placed at the fistula for orientation. Re-entry through the fistula confirmed one lumen with clips and the other leading to the ileocecal valve, indicative of intestinal duplication ([Fig. 4], [Fig. 5], [Video 1]).

Fig. 4 a, b Two titanium clips placed around the fistula opening, used to distinguish between the two intestinal lumina. c The ileocecal region could be reached through the intestinal lumen where no titanium clips were placed. d The double-lumen structure of the small intestine.

Fig. 5 Schematic diagram of the intestinal duplication in this case. Source: modified according to Servier Medical Art under the license https://creativecommons.org/licenses/by/4.0/

Diagnosis of small intestine duplication with enteroscopy and capsule endoscopy.Video 1

An upper gastrointestinal (GI) contrast study revealed normal transit of barium through the stomach, duodenum, and jejunum. However, 1 hour post-administration, the patient was too unwell to cooperate. During the capsule endoscopy examination, we successfully re-located the titanium clips that were placed during the endoscopic procedure and confirmed the double-lumen structure of the small intestine, providing crucial evidence for the diagnosis of the case.

This case report successfully diagnosed a rare tubular duplication of the small bowel in an adult female using endoscopic titanium clip localization. Despite imaging studies not revealing significant abnormalities, endoscopy uncovered the lesion, demonstrating its unique value in identifying complex gastrointestinal pathologies. The article highlights the importance of endoscopy in diagnosing atypical symptoms and provides clinicians with new perspectives for managing similar cases.

Endoscopy_UCTN_Code_CCL_1AC_2AF

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Ildstad ST, Tollerud DJ, Weiss RG. et al. Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations. Ann Surg 1988; 208: 184-189
• 2 Puligandla PS, Nguyen LT, St-Vil D. et al. Gastrointestinal duplications. J Pediatr Surg 2003; 38: 740-744
• 3 Domajnko B, Salloum RM. Duplication cyst of the sigmoid colon. Gastroenterol Res Pract 2009; 2009: 918401

Publication History

Article published online:
19 September 2024