TL;DR
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A case report describes an infant whose abdominal distention, vomiting and constipation were linked to a complete duplication of the colon and rectum. Because the duplicated and native colons shared a blood supply, surgeons joined the two passages instead of removing the duplicate; the child was doing well at one-year follow-up.
An infant treated for abdominal distention, vomiting and constipation was found to have a second colon and rectum, according to a case report in BMJ Case Reports. Surgeons joined the two colons rather than remove the duplicated section, because both shared a blood supply; the child was reported to be doing well one year later.
The child was first assessed at an emergency department, where clinicians suspected a partial bowel obstruction, and was transferred to a specialist pediatric surgical center. There, a step-by-step investigation used several imaging methods. A CT scan with 3D reconstruction showed two separate colonic passages descending into one anal canal, with no other anomalies reported.
Surgeons confirmed the duplication during an operation called a laparotomy. The extra colon was heavily impacted with fecal material and shared a wall and a single mesentery with the native colon. The team said removing the duplicated colon could have put blood flow to the entire colon at risk. Instead, they divided the shared wall to connect the two colons.
The child recovered quickly, tolerated feeding through the digestive tract and was discharged seven days after surgery, according to the report. A barium enema at six weeks showed normal colonic anatomy with some remaining dilation. The team reversed the ileostomy at 10 weeks after surgery. At one-year follow-up, the child was passing soft stool daily and was described as thriving; stool softeners were still needed intermittently for constipation.
The case shows how an unusual anatomical finding can change the surgical plan. Although the duplicated section was obstructed with stool, its shared mesenteric blood supply meant that removing it could have compromised circulation to the remaining colon. The team instead chose to open the common wall between the two passages, aiming to relieve the problem while preserving the colon.
It also highlights the diagnostic challenge posed by rare bowel duplications. The researchers said these abnormalities can occur anywhere along the digestive tract and have a broad range of symptoms. In this infant, specialists combined the clinical history, multiple imaging methods and surgical findings before settling on an approach. The case does not establish how commonly constipation in children signals an anatomical condition; it describes one rare diagnosis and its treatment.
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A Rare Form of Bowel Duplication
Duplications of the alimentary canal can occur from the mouth to the anus. The researchers cited an estimated rate of about one case per 4,500 births for alimentary canal duplications overall. More than 80% present before a child turns 2, they reported, and males and females are affected equally.
Colon duplications account for an estimated 13% to 15% of alimentary canal duplications, according to the report. A duplication involving the entire colon is much rarer, particularly in an infant, and the authors said only a few such cases had been reported in the United Kingdom. Those figures concern duplications of the digestive tract generally and should not be read as the rate of complete colonic duplication.
The child’s parents said they had noticed green stools for four to five months and had raised concerns, but were reassured that the color fell within the normal range. They wrote that, in hindsight, this was a significant indicator. That is the family’s account in the case report; the report does not establish that green stool alone can identify bowel duplication.
““Everyone just attributed it to straightforward constipation without stopping to think, why? Is there something else going on?””
— Lynn Sinitsky, MBBS, of West Hertfordshire Teaching Hospitals NHS Trust, speaking to MedPage Today
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What Follow-Up Has Not Established
The report offers a favorable update at one year, but it does not provide longer-term follow-up. The authors said they expected long-term functional outcomes to be favorable based on the child’s progress so far; that is an expectation, not a confirmed outcome over many years. The child still intermittently needs stool softeners, and the report does not say whether that need will continue.
The case also cannot establish how often persistent constipation or green stools indicate a structural abnormality. It documents one infant’s course, not a diagnostic rule for other children. The source material does not provide further details about the child’s current age, later growth measurements or additional imaging beyond the reported follow-up.
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Ongoing Bowel and Growth Monitoring
The case report describes continued normal bowel habits, appetite and growth at the time of its one-year update, with intermittent stool-softener use. It does not announce another scheduled scan or a specific next clinical milestone. Continued follow-up is the next step described by the child’s ongoing care, while the authors’ prediction of favorable long-term function remains subject to future observation.
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Key Questions
What did doctors find in the infant?
Imaging and surgery showed a duplication of the colon and rectum: two colonic passages descended into one anal canal. The duplicate section contained impacted stool.
Why did surgeons connect the colons instead of removing one?
The duplicated and native colons shared a wall and mesenteric blood supply. The surgeons said removing the duplicate could have jeopardized blood flow to the entire colon, so they divided the common wall to join the passages.
How was the child doing after surgery?
The report says the infant recovered, went home seven days after surgery and later had the ileostomy reversed. At one-year follow-up, the child was thriving and passing soft stool daily, though stool softeners were needed intermittently.
Does the case mean green stool indicates a duplicated colon?
No. The report records the parents’ observations of green stools, but it does not show that green stool alone identifies a bowel duplication. The findings describe a single rare case, not a general diagnostic test.
Source: rss
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