TL;DR
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A case report describes an infant whose abdominal swelling, vomiting and constipation led specialists to find a complete duplication of the colon and rectum. Surgeons connected the duplicated bowel to the native colon rather than remove it, because both shared a blood supply; the child was reported to be doing well one year later.
Surgeons treating an infant for suspected partial bowel obstruction found a rare duplication of the colon and rectum, according to a case report in BMJ Case Reports. Because the two colons shared a blood supply, doctors connected their channels rather than remove the duplicated section; the child was reported to have normal bowel habits one year later.
The boy was taken to an emergency department with abdominal distention, vomiting and constipation, then transferred to a specialist pediatric surgical center. Imaging there, including a CT scan with 3D reconstruction, showed two separate colonic channels leading to one anal canal, with no other anomalies identified, the report said.
Surgeons confirmed the duplication during an abdominal operation. The additional colon was heavily impacted with stool and shared a wall and a single mesentery with the normal colon. The researchers said removing it risked disrupting blood flow to the entire colon. Instead, the team divided the shared wall to connect the two channels. The child had a temporary ileostomy, which was reversed 10 weeks after surgery.
The report says the infant recovered quickly, tolerated feeding through the digestive tract and left hospital on the seventh day after surgery. A contrast X-ray at six weeks showed normal colonic anatomy, though some dilation remained. At the one-year follow-up, the child was growing and had regular bowel habits, with occasional use of stool softeners, according to the clinicians.
Why the Anatomy Changed Surgery
The case shows why persistent or pronounced symptoms in an infant may warrant further investigation, particularly when abdominal swelling accompanies constipation. Here, imaging and specialist review identified an anatomical cause that would not have been treated by removing the duplicated bowel without risking its shared blood supply.
The authors describe complete duplication of the colon as an extremely rare presentation. They cite alimentary-tract duplications overall at about one in 4,500 births, while duplications of the colon make up 13% to 15% of those cases. These figures refer to different levels of rarity and do not establish how often total colonic duplication occurs. The report is a single case, not evidence about how commonly constipation signals an anatomical condition.
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How Doctors Identified the Duplication
The family told the authors that they had noticed concerns from an early age, including green stools for four to five months. They said they had raised the issue but were reassured that green stools could fall within the normal range. In comments included with the report, the parents said they later viewed the stool color as an indicator of an underlying problem. The case report does not establish that green stool alone diagnoses bowel duplication.
At the first hospital, clinicians suspected a partial obstruction and arranged transfer to a specialist surgical center. There, a stepwise assessment using multiple imaging methods helped define the anatomy before surgery. The report says more than 80% of alimentary-tract duplications present before age two, but a complete duplication of the colon is particularly uncommon and can present in different ways.
Lynn Sinitsky, a clinician at West Hertfordshire Teaching Hospitals NHS Trust in Watford, U.K., and colleagues reported the case. Sinitsky told MedPage Today that the team’s approach involved reviewing the infant’s history together and working with radiologists to select imaging that could guide the operation.
“Everyone just attributed it to straightforward constipation without stopping to think, why? Is there something else going on?”
— Lynn Sinitsky, West Hertfordshire Teaching Hospitals NHS Trust, speaking to MedPage Today
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Limits of the One-Year Follow-Up
The report documents the child’s recovery and condition at one year, but longer-term outcomes are not yet known. The authors said they expected favorable long-term function based on progress so far; that is an expectation, not a confirmed long-term result. The child also intermittently needed stool softeners, despite having a normal bowel habit overall.
The case does not establish whether the earlier symptoms, including green stools, were specific signs of the duplication or how often similar symptoms in other infants have an anatomical cause. Nor does one successful surgical approach determine how other cases should be treated: the anatomy and shared blood supply informed this team’s decision.
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Monitoring Bowel Function Over Time
The case report says the child continues to be monitored, with no further reported concerns about bowel habits, abdominal distention, appetite or growth at the time described. Long-term follow-up will show whether bowel function remains stable after the reconstruction and ileostomy reversal.
Sinitsky said careful assessment of constipation in children under one year old, especially when accompanied by substantial abdominal distention, and collaboration among healthcare professionals can affect how a case is investigated. The report gives no further planned tests or dates for future follow-up.
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Key Questions
What did surgeons find?
They found a duplication of the colon and rectum: two colonic channels descended into one anal canal. The duplicated section was impacted with stool and shared a wall and blood supply with the native colon.
Why did surgeons connect the colons instead of removing one?
The two channels shared a mesentery and blood supply. The authors said removing the duplicated colon could have jeopardized blood flow to the entire colon, so surgeons divided the shared wall to connect the channels.
How did the child recover?
According to the case report, the infant tolerated feeding and was discharged on the seventh day after surgery. The temporary ileostomy was reversed at 10 weeks, and at one year the child had a normal bowel habit, with occasional stool-softener use.
Does green stool mean a child has a duplicated colon?
No. The report recounts the parents’ concerns about green stools but does not say that this symptom identifies bowel duplication. It describes one rare case and cannot establish what a particular symptom means for another child.
Is the child’s long-term outcome known?
Only the first year after surgery is described. The authors said they expected favorable long-term function based on the child’s progress, but longer-term results have not been reported.
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