Long segment tubular small bowel duplication in a four year old child: a rare case report from a resource limited setting, Woldia, Ethiopia

Abstract

Alimentary tract duplications are rare congenital anomalies, with tubular variants representing less than 10% of all presentations. Long-segment tubular duplications of the small bowel are exceptionally uncommon. A 4 year old male child presented with a history of recurrent colicky abdominal pain, subjective high grade fever, decreased oral feeding, and an episode of diarrhea. Laboratory findings showed microcytic hypochromic anemia (HGB = 8.8 g/dL). A subsequent post-contrast abdominopelvic CT scan revealed a localized, well-defined cystic lesion measuring approximately 3.3 × 2.7 cm adjacent to the distal third part of the duodenum. However, exploratory laparotomy unexpectedly revealed a massive, continuous, non-communicating 31 cm long “double-barrel” tubular duplication situated along the distal ileum terminating 15 cm proximal to the ileocecal valve. The duplicated segment shared a common mesenteric border and vascular supply with the native ileum. Segmental bowel resection of the entire affected 31 cm loop followed by a primary end to end ileo-ileal anastomosis was performed. The postoperative recovery was uneventful. Tubular enteric duplications are rare congenital anomalies that are frequently difficult to diagnose preoperatively because imaging may underestimate their extent. Complete surgical excision remains the treatment of choice to prevent future complications. This case highlights that extensive tubular duplications can easily simulate localized cystic masses on cross-sectional imaging due to mechanical collapse or fluid redistribution, leading to profound preoperative discrepancies. Surgical resection remains mandatory, and awareness of this variant is essential to prevent unintended mesenteric vascular injury during mobilization in low-resource surgical centers.