Ileal duplication mimicking intestinal intussusception: a congenital condition rarely reported in adult

Abstract

Intestinal duplication is an uncommon congenital condition in young adults. A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis. Abdominal discomfort and pain, suggestive of intestinal obstruction, recurred after operation. A tubular mass was palpable in the right lower quadrant. Computed tomography enterography scan identified suspicious intestinal intussusception, while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant. On exploratory laparotomy, a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve. Ileectomy was performed along with the removal of the duplication disease, and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity. Pathological examination showed ileal duplication with ectopic gastric mucosa. The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.

Keywords: Adulthood; Computed tomography enterography; Ileal duplication cyst; Tc-99m pertechnetate scintigraphy.

Figure 1

Computed tomography enterography scan. A: Transverse view showed suspicious ileal intussusception (white arrow) in the right lower quadrant; B: Coronal view revealed a similar result (white arrow).

Figure 2

Tc-99m pertechnetate scintigraphy. A cluster of stripy abnormal radio-activity was located in the right lower quadrant.

Figure 3

Exploratory laparotomy findings. A: A 25-cm duplicating, tubular small intestinal segment was found arising from the ileal mesenteric margin; B: This duplication cyst was intimately attached to the native ileal segment located 15 cm proximal to ileocecal valve; C: this cyst had a blind end proximally and a completely patent orifice into the native ileal lumen distally.

Figure 4

Gross and histological pathology of the resection specimen. A: The resection specimen showed no signs of inflammation, infection, ulceration, hemorrhage, obstruction, or malignant transformation; B: The mucosal layer of the duplication cyst was lined with both small intestinal and gastric mucosae; C: Histology revealed that the duplication cyst was lined with ileal mucus glands and heterotopic gastric mucosae (hematoxylin-eosin, × 100).