A rare diagnosis in the operation room: Kidney atrophy due to duplicated colon in an adult

Feb 25 2008

Gastrointestinal congenital anomalies are rare entities in an adult patient.

Commonly they are located in the upper gastrointestinal system and present with intestinal symptoms such as bleeding, obstruction and/or perforation of the intestine. One extraordinary case of colon duplication was recently reported in the January 28 issue of the World Journal of Gastroenterology because of its great significance in presenting with hydronephrotic atrophy of the right kidney, rather than gastrointestinal symptoms, in an adult. This article will undoubtedly be of interest to health professionals.

The article describes a male patient who presented to Dr. Sahin Kabay and Dr. Faik YAYLAK of Dumlupinar University Hospital, Turkey, in 2006. This patient was quite a challenge for Dr. Kabay and Dr. Yaylak. He was a 28-year-old man with a palpable mass in the right flank. He was undiagnosed for his intermittent complaints of right flank pain for several months.

The initial efforts were to treat and to control his urinary tract infection. At primary diagnostic imaging studies, Dr. Kabay and Dr. Yaylak noted the mass in the right flank with hydronephrosis of the right kidney. Their further efforts to clarify the origin of the mass with intravenous pyelography, scintigraphy and even colonoscopy were not enough to make a diagnosis pre-operatively. Computed tomography images demonstrated the continuum of the mass with the right colon. Dr. Kabay and his surgical team scheduled their patient for a laparotomy under general anesthesia. During the operation, the surgical team was excited to diagnose the double tubular colon as the cause of the pathological mass. The mass with duplicated colon and appendix was removed uneventfully. The postsurgical course of the patient was not significant and he recovered well over the following year.

In an effort to make a correct diagnosis in the patient, Dr. Kabay and Dr. Yaylak were forced to carry out a fine pre-operative diagnostic workup. However, only when an operation room became available were they able to make the final diagnosis of a rare congenital anomaly of the gastrointestinal system.