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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