Pediatr Gastroenterol Hepatol Nutr.  2015 Sep;18(3):197-201. 10.5223/pghn.2015.18.3.197.

Tubular Colonic Duplication Presenting as Rectovestibular Fistula

• Karkera PJ
• Bendre P
• D'souza F
• Ramchandra M
• Nage A
• Palse N

• KMID: 2068798
• DOI: http://doi.org/10.5223/pghn.2015.18.3.197

Abstract

Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in about 15% of all gastrointestinal duplications. Double termination of tubular colonic duplication in the perineum is even more uncommon. We present a case of a Y-shaped tubular colonic duplication which presented with a rectovestibular fistula and a normal anus. Radiological evaluation and initial exploration for sigmoidostomy revealed duplicated colons with a common vascular supply. Endorectal mucosal resection of theduplicated distal segment till the colostomy site with division of the septum of the proximal segment and colostomy closure proved curative without compromise of the continence mechanism. Tubular colonic duplication should always be ruled out when a diagnosis of perineal canal is considered in cases of vestibular fistula alongwith a normal anus.

Keyword

Rectovestibular fistula; Colonic duplication; Tubular duplication

MeSH Terms

Anal Canal
Colon*
Colostomy
Diagnosis
Fistula*
Perineum

Figure

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  Fig. 1 Clinical picture showing 3 openings in the vestibuleurethra (foley catheter), vagina, vestibular fistula (infant feeding tube), in addition to the normal sited anus.

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  Fig. 2 Intra-operative picture showing duplicated colon (arrow points to the duplicated segment at the mesenteric border of native colon).

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  Fig. 3 Distal and proximal cologram showing duplicated colon with 2 separate lumens (arrow points to negative shadow of the intervening septum between the duplicated colons).

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  Fig. 4 Diagrammatic presentation of the anatomy.

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  Fig. 5 Mucosal resection (arrow-mucosal cuff) of the distal duplicated colon.

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  Fig. 6 Septum (arrow) between the duplicated colons.

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