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There’s more than meets TI

A rare case of a 68-year-old female presented with ileal diverticulitis and intestinal malrotation. The patient made a full recovery with IV antibiotics and fluids. No further investigations planned. Discussion on embryology, future implications, and references provided.

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There’s more than meets TI

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  1. There’s more than meets TI Dr Douglas Black, Radiology ST4 Dr Karen Gray, Radiology Consultant University Hospital Hairmyres Lanarkshire, Scotland

  2. Clinical Information A 68 year-old female patient presented with left iliac fossa pain. She had localised abdominal tenderness and pyrexia. The working diagnosis was sigmoid diverticulitis, and a CT was requested…

  3. Terminal ileal diverticulitis

  4. The TI can be followed to the caecum

  5. What is this?

  6. Second caecum Ileocaecal valves

  7. Findings So Far • Distal ileal diverticulitis • Intestinal malrotation • Two caeca and distal ilea

  8. Rectum Rectum

  9. Rectum Rectum

  10. Bladder

  11. Bladder

  12. Urachal ligaments

  13. Summary of Findings • Ileal diverticulitis • Intestinal malrotation • Large bowel duplication • Ileal duplication • Bladder duplication

  14. Diagnosis and Clinical Outcome The patient was treated with intravenous antibiotics and fluids, and made a full recovery. At this point in time, no further investigations are planned…

  15. Discussion There are no other documented cases of such an extensive duplication. Most reports detail isolated intestinal duplication cysts, predominantly in children. The few reported long-segment duplications presented with obstruction due to a blind end or insufficient fistulous tract.

  16. Embryology • Split notochord theory • Defects in recanalisation • Partial twinning • Tubular vs cystic duplications • Associated genitourinary malformations

  17. Discussion There are potential future implications for both the patient and clinician with such an anomaly. Although there is currently no clinical concern, further imaging (e.g. MRI pelvis/rectum) to delineate anatomy may provide useful information for the clinical team.

  18. References • Huang Z-H, Wan Z-H, Vikash V, Vikash S, Jiang C-Q. Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin. Sao Paulo Medical Journal. scielo; 2018;136:89–93. • KhaleghnejadTabari A, Mirshemirani A, KhaleghnejadTabari N. Complete colonic duplication in children. Caspian journal of internal medicine. Babol University of Medical Sciences; 3(2):436–9. • GajbhiyeV, Nath S, Ghosh P, Chatterjee A, Haldar D, Das SK. Complete duplication of the urinary bladder: An extremely rare congenital anomaly. Urol Ann. 2015 Jan;7(1):91–3. • Withers A, Loveland J, Grieve A. Gastro-intestinal duplication cyst with associated malrotation and volvulus in a 5-week-old infant. Journal of Pediatric Surgery Case Reports. 2018;29:49–51. 1. • McPherson AG, Trapnell JE, Airth GR. Duplication of the colon. Br J Surg. 1969 Feb;56(2):138–42. • Wu X, Xu X, Zheng C, Li B. Tubular colonic duplication in an adult: case report and brief literature review. J Int Med Res. 2018 Jun 4;46(7):2970–5. • GopalSC, Gangopadhyay AN, Gupta DK, Sinha CK, Sahoo SP, Sharma LB. A unique presentation of atypical complete duplication of terminal ileum, colon, rectum, and urinary bladder. Journal of Pediatric Surgery. 1997;32(8):1250–1. • Kothari M. Tubular duplication of colon and terminal ileum in a female child, case report, review of literature and proposal of a new classification. Journal of Pediatric Surgery Case Reports. 2015;3(11):512–6.

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