Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin

Huang, Zhi-Hao; Wan, Zi-Hao; Vikash, Vikash; Vikash, Sindhu; Jiang, Cong-Qing

doi:10.1590/1516-3180.2017.0184030817

Zhi-Hao Huang

MD, MSc. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.

Zi-Hao Wan

MD, MSc. Surgeon, Department of Orthopedic Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.

Vikash Vikash

MD, PhD. Physician, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.

Sindhu Vikash

MD, PhD. Physician, Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan.

Cong-Qing Jiang

MD, PhD. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.

http://orcid.org/0000-0002-5063-6299

Address for correspondence: Cong-Qing Jiang Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University 169 Donghu Road Wuhan - Hubei Province 430071 - China Tel. + 86-027-67812960 E-mail: wb002554@whu.edu.cn

Conflict of interest: None

Figures (5)
Tables (1)

Thumbnail

Figure 1:
Abdominal radiograph: multiple gas-liquid planes in the intestinal gut.

Thumbnail

Figure 2:
Abdominal ultrasonography: (A) A distended bowel can be seen below the umbilicus, and peristalsis is not apparent. The wall of the tube is thickened, and the lumen at the beginning of its expansion is compressed. (B) A dark area is seen between the intestines. (C) The intestinal wall is raised into the lumen, and the two intestinal tubes share the same wall of the bowel canal. (D) A small amount of colored blood flow signal can be seen on the wall of the dilated intestinal tube.

Thumbnail

Figure 3:
Abdominal and pelvic computed tomography examination: A large cystic mass with a clear boundary can be seen.

Thumbnail

Figure 4:
Intraoperative findings (gross specimens): (A) The mass was generally ischemic, with darker color; the surface was covered with pus and no perforation was found; the proximal segment of the small intestine was dilated and hypertrophic, with inflammatory edema and punctate ischemia. (B) The basement wall was relatively weak, and the border of the normal bowel was clear. (C) Twisted sticky joints at the base of the mass compressed the adjacent normal intestinal canal.

Thumbnail

Figure 5:
Pathological findings: (A) Small bowel cystic lesions: hemorrhage and necrosis were observed in the intestinal wall, and mesenteric vascular dilatation and congestion were observed, which was consistent with bleeding and necrotic alterations in the volvulus (hematoxylin and eosin staining, magnification x 100). (B) Intestinal ischemia and inflammatory tissue: examination of intestinal wall tissue showed presence of a mucosal layer of chronic inflammatory cell infiltration, with submucosal edema and thickening, while the smooth muscle layer was not abnormal (hematoxylin and eosin staining, magnification x 100).

Thumbnail

Table 1:
Summary of adult patients with small intestinal duplications as found in the United States National Institutes of Health’s National Library of Medicine (PubMed) database as of July 20, 2017

Database	Search strategies				Papers found	Related papers
MEDLINE (via PubMed)	(((“Adult”[Mesh]) AND “Intestine, Small”[Mesh]) AND “Congenital Abnormalities”[Mesh]) AND duplication[Title/Abstract]				40	20
Study (year)	Age (years)/gender	Presenting features	Surgical treatment	Form	Size (cm)	Malignancy
^{Ho (2012}3. Ho YC. Total colorectal and terminal ileal duplication presenting as intussusception and intestinal obstruction. World J Gastroenterol. 2012;18(43):6338-40.)³	25/male	Abdominal pain	Yes	Tubular	NR	No
^{Vivier et al. (2013}4. Vivier PH, Beurdeley M, Bachy B, Aguilella C, Ickowicz V, Lemoine F, et al. Ileal duplication. Diagn Interv Imaging. 2013;94(1):98-100.)⁴	32/female	Routine control examination	Yes	Cystic	2	No
^{Handra-Luca et al. (2013}5. Handra-Luca A. Adult ileal duplication revealed by a colon adenoma. Surg Today. 2013;43(11):1335-6.)⁵	65/male	Routine control examination	Yes	Tubular	8	Yes
^{Barbosa et al. (2015}6. Barbosa L, Soares C, Povoa AA, Maciel JP. Ileal duplication: an unusual cause of intestinal obstruction in adult life. BMJ Case Rep. 2015;2015.)⁶	36/male	Abdominal pain, vomiting	Yes	Cystic	NR	No
^{Yu et al. (2014}7. Yu Y, Wu JS, Ke ZW. Giant chylous cyst and ileal duplication in a young adult. Singapore Med J. 2014;55(5):e77-81.)⁷	24/female	Abdominal pain	Yes	Cystic	28 × 20	No
^{Li et al. (2013}8. Li BL, Huang X, Zheng CJ, Zhou JL, Zhao YP. Ileal duplication mimicking intestinal intussusception: a congenital condition rarely reported in adult. World J Gastroenterol. 2013;19(38):6500-4.)⁸	25/male	Abdominal pain, weight loss	Yes	Tubular	15.5 × 4	No
^{Nussbaum et al. (2014}9. Nussbaum DP, Bhattacharya SD, Jiang X, Cardona DM, Strickler JH, Blazer DG, 3rd. Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication. Arch Pathol Lab Med. 2014;138(3):428-31.)⁹	51/male	Abdominal pain, bloody stools	Yes	Tubular	9.5 × 2	Yes
^{Kim et al. (2014}10. Kim HS, Sung JY, Park WS, Kim YW. An ileal duplication cyst manifested as an ileocolic intussusception in an adult. Turk J Gastroenterol. 2014;25 Suppl 1:196-8.)¹⁰	19/female	Abdominal pain	Yes	Cystic	2,5	No
^{Park et al. (2014}11. Park JY, Her KH, Kim BS, Maeng YH. A completely isolated intestinal duplication cyst mimicking ovarian cyst torsion in an adult. World J Gastroenterol. 2014;20(2):603-6.)¹¹	36/female	Abdominal pain	Yes	Cystic	12	No
Martínez-Alcala et al. (2014)¹²	37/female	Abdominal pain, vomiting	Yes	Cystic	5	No
^{Furuya et al. (2012}13. Furuya K, Hada M, Sugai H, Miyasaka Y, Nakagomi H, Oyama T, et al. Gastrointestinal stromal tumor arising in an ileal duplication: report of a case. Surg Today. 2012;42(12):1234-9.)¹³	70/female	Abdominal pain	Yes	Cystic	3	Yes
^{Miloudi et al. (2012}14. Miloudi N, Mzoughi Z, Ben Abid S, Sabbagh S, Arfa N, Khalfallah MT. [Duodenal duplication treated surgically]. La Tunisie medicale. 2012;90(11):837-8.)¹⁴	26/male	Abdominal pain, vomiting	Yes	Cystic	4	No
^{Palacios et al. (2013}15. Palacios A, De Vera M, Martinez-Escoriza JC. Prenatal sonographic findings of duodenal duplication: case report. J Clin Ultrasound. 2013;41 Suppl 1:1-5.)¹⁵	35/female	Routine control examination	Yes	Cystic	1.3	No
^{Antaki et al. (2013}16. Antaki N, Abboud D, Lemmers A, Antaki F, Deviere J. Acute recurrent pancreatitis secondary to the rare association of a duodenal duplication cyst and a pancreas divisum. Clin Res Hepatol Gastroenterol. 2013;37(1):e32-6.)¹⁶	21/male	Abdominal pain	Yes	Cystic	NR	No
^{Kusnierz et al. (2014}17. Kusnierz K, Pilch-Kowalczyk J, Gruszczynska K, Baron J, Lucyga M, Lampe P. A duodenal duplication cyst manifested by duodenojejunal intussusception and chronic pancreatitis. Surgery. 2014;156(3):742-4.)¹⁷	31/female	Abdominal pain, nausea, lack of appetite	Yes	Cystic	2.9 × 2.6	No
^{Cheng et al. (2014}18. Cheng CL, Liu NJ, Yu MC. Intraluminal tubular duodenal duplication with bleeding. Clin Gastroenterol Hepatol. 2014;12(2):e10-1.)¹⁸	49/male	Gastrointestinal bleeding, melena passage	Yes	Cystic	NR	No
^{Kurien et al. (2014}19. Kurien RT, Chowdhury SD, Unnikrishnan LS, Simon EG, Dutta AK, Mahanta K, et al. Endoscopic treatment of a duodenal duplication cyst. Endoscopy. 2014;46 Suppl 1 UCTN:E583-4.)¹⁹	NR/female	Abdominal pain	Yes	Cystic	NR	No
^{Kachi et al. (2016}20. Kachi A, Haddad F, Geagea A, Tohmeh MJ. Unusual case of jejunal duplication in a 64-year-old female. J Med Liban. 2016;64(1):50-3.)²⁰	64/female	Abdominal pain	Yes	Cystic	4	No
^{Gupta et al. (2016}21. Gupta A, Chakaravarthi K, Pattnaik B, Kaman L. Duplication cyst of ileum presenting as acute intestinal obstruction in an adult. BMJ Case Rep. 2016;2016.)²¹	20/male	Constipation, vomiting	Yes	Cystic	NR	No
^{Inoue et al. (2016}22. Inoue K, Sakiyama T, Setoyama K, Iwashita Y, Saito S, Hanada N, et al. [Jejunal duplication in an adult presenting with hematochezia]. Nihon Shokakibyo Gakkai Zasshi. 2016;113(4):662-71.)²²	56/male	Appetite loss, palpitations, orthostatic syncope, hematochezia	Yes	Cystic	NR	No

[1] Address for correspondence: Cong-Qing Jiang Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University 169 Donghu Road Wuhan - Hubei Province 430071 - China Tel. + 86-027-67812960 E-mail: wb002554@whu.edu.cn

Brasil

Brasil

Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin

ABSTRACT

CONTEXT:

CASE REPORT:

CONCLUSION: