Doubly Communicating Rectal Duplication
- PDF / 2,498,680 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 73 Downloads / 221 Views
GI IMAGE
Doubly Communicating Rectal Duplication Juliet June Ray 1 & Pooja Padmini Venkatesh 1 & Bari Dane 2 & Feza Remzi 1 Received: 8 October 2020 / Accepted: 31 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Case Presentation A 42 year old man with no past medical history presented to clinic with seven days of fecal impaction and sensation of incomplete rectal emptying. He noted rectal prolapse with straining over several years but had never had bleeding or other complication with this. His physical exam, including rectal exam, was unremarkable. He was scheduled for colonoscopy after initial management with bowel regimen failed to improve his symptoms. Colonoscopy revealed two lumens diverging in the rectum (Fig. 1a). The scope followed the main lumen into the sigmoid and was then withdrawn to pass into the second lumen, which appeared to be healthy colonic mucosa. The second lumen rejoined the sigmoid proximally. To further evaluate the anatomy, a pelvic MRI with and without IV contrast and rectal contrast was obtained. GRASP T1 post-contrast imaging showed the duplication cyst located anterior to the rectum. The cyst merged with the rectum 4.5 cm inferior to the anal verge (Fig. 1b) and merged again with the sigmoid colon superiorly (Fig. 1c). Retrograde contrast filled both lumens (Fig. 1d).
* Juliet June Ray [email protected] Pooja Padmini Venkatesh [email protected] Bari Dane [email protected] Feza Remzi [email protected] 1
Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
2
Department of Radiology, NYU Langone Health, New York, NY, USA
The patient had no polyps or findings concerning for malignancy or obstruction. He will be followed with routine surveillance and a bowel regimen.
Discussion Colonic duplications are a rare form of enteric duplication with only 83 cases reported in the literature between 1950 and 2005. They account for only 4–18% of all gastrointestinal duplications and are often asymptomatic and thus go undiagnosed.1 When symptomatic, colonic and rectal duplications can present with bleeding, obstruction, constipation, abdominal pain, and/or intussusception.1, 2 Two thirds of these cases present before age two.1 Colonic duplications are found adjacent to the normal intestine, can be lined with multiple types of gastrointestinal mucosa, and are surrounded by at least one outer smooth muscle layer.1 Unlike Meckel’s diverticula, enteric duplication cysts are solely found on the mesenteric border of the colon.2 These cysts may or may not have one or more direct communications with the adjacent part of the bowel across the common septum.3 There are four theories to explain how duplications occur during embryonic development. Bremer proposed that a failure to recanalize contributes to this condition, while Lewis and Thyng proposed that duplication cysts arise from diverticula present during development. A split notochord theory for neurenteric duplications associated with vertebral anomalies was brought forth by Bentley and
Data Loading...
