TOTAL TUBULAR COLONIC AND APPENDICEAL TRIPLICATION CYSTS WITH AN ILEAL DUPLICTION AND RECTOVAGINAL FISTULA: A CASE REPORT AND LITERATURE REVIEW

Teboho Shabalala, Hansraj Mangray, Sanele Madziba, Amanda Ngobese, Yashlin Govender,

Tafadzwa Dube-Zhiruvik, Zizodwa Nginase

[1] Department of Paediatric Surgery, Grey’s Hospital in Pietermaritzburg, and

[2] College of Health Sciences - Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Abstract

Introduction: There are few cases reported with total colonic triplication in the literature, and none have been reported with the association of ileal duplication, triplicated appendix, and rectovaginal fistula. Our case is the first in the literature where total colonic triplication is associated with all the above-mentioned abnormalities.

Case report: A unique case of a total tubular colonic triplication, ileal duplication, triplicated appendix associated with a rectovaginal fistula in a 5- month-old female who presented with a history of stool draining from the vagina and anus, as well as a mass prolapsing from the anus when straining. The digital rectal exam could not advance more than a centimeter (cm). Diagnostic laparoscopy showed a dilated colon, and a divided colostomy showed three lumens proximally and distally. Stool is draining through two lumens postoperatively. CT imaging confirmed total colonic triplication. Laparotomy showed duplication of the terminal ileum 25cm, both

communicating with a triplicated caecum, triplication of the appendix, and total colonic triplication. There was no evidence of bowel obstruction, but a rectovaginal fistula was confirmed. A colostomy was brought down,

appendicectomy was performed, and the colon was shaved off the vagina. The vaginal defect was repaired, then enterotomy was extended, and a common rectal channel was created. The rectal wall was repaired, and the divided colostomy was redone with each stoma having three lumens. Albeit a coarse recovery in PICU, our patient has been discharged home. On follow-up, she is growing, and the stoma is functioning well.

Conclusion: Colonic triplication is rare with complex anatomy; management should be multidisciplinary, and surgical intervention should be reserved for patients who are symptomatic or at risk of complications.