Large bowel obstruction in an adolescent caused by dolichocolon and a fibrotic band of Toldt: A rare case report

Abstract

Background: Large bowel obstruction (LBO) is uncommon in adolescents and often presents a diagnostic challenge due to its rarity and atypical causes compared to adults. Dolichocolon, a congenital elongation of the colon, and congenital fibrotic bands such as the band of Toldt are rarely reported causes of LBO in this age group.

Case-presentation: We report a 17-year-old female with no prior medical or surgical history who presented with diffuse abdominal pain, obstipation, and abdominal distension. Imaging revealed a large bowel obstruction with a transition zone at the splenic flexure. Exploratory laparotomy identified a fibrotic band of Toldt causing extrinsic compression of the colon in the setting of dolichocolon with severe colonic dilatation. The patient underwent subtotal colectomy with ileosigmoid anastomosis. Postoperative recovery was uneventful, and the patient was discharged in good condition.

Discussion: This case highlights the importance of considering congenital anatomical variants such as dolichocolon and fibrotic peritoneal bands in adolescents presenting with LBO, especially in the absence of prior surgery or malignancy. Early recognition and timely surgical intervention are crucial to prevent morbidity.

Conclusion: Dolichocolon combined with a fibrotic band of Toldt is a rare but significant cause of LBO in adolescents. Awareness of such anomalies can facilitate accurate diagnosis and appropriate management, leading to favorable outcomes.

Keywords: Case report; Congenital bands; Dolichocolon; Fibrotic band of Toldt; Large bowel obstruction.

Fig. 1

Collapse of the descending colon observed on CT scan.

Fig. 2

Dilatation of the sigmoid colon evident on CT scan.

Fig. 3

Intraoperative view showing massively dilated sigmoid colon.