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A case report describes an infant whose abdominal distention, vomiting and constipation led doctors to discover a duplicated colon and rectum. Surgeons joined the duplicated and native colons rather than remove one, because they shared a blood supply; the child was doing well at one-year follow-up, according to the report.
Surgeons treating an infant for abdominal distention, vomiting and constipation discovered that he had a second colon and rectum, according to a case report published in BMJ Case Reports. Because the duplicated bowel shared a blood supply with the normal colon, the team joined the two sections rather than remove the duplicate; the child was reported to be doing well one year later.
The boy was first assessed in an emergency department, where doctors suspected a partial bowel obstruction, and was transferred to a specialist pediatric surgical center. Imaging there included a CT scan with 3D reconstruction. It showed two separate colonic channels leading to one anal canal, with no other anomalies identified in the imaging described by the report.
Surgeons confirmed the duplication during an operation called a laparotomy. They found the extra colon heavily impacted with stool and attached to the native colon by a shared wall and a single mesentery and blood supply. The report’s authors said removing the duplicated section could have endangered blood flow to the entire colon. Instead, they divided the shared wall to connect the two colons.
The child recovered quickly, tolerated feeds and went home on the seventh day after surgery, the report said. A barium enema six weeks later showed normal colonic anatomy, with some remaining dilation. Doctors reversed the ileostomy 10 weeks after surgery. At follow-up, he was passing soft stools daily and sometimes needed stool softeners; the authors reported no further concerns about bowel habits, abdominal distention, appetite or growth.
The case shows how an unusual anatomical finding can alter the operation doctors consider. Although removing the second colon might seem like a direct solution to stool impaction, the team reported that the shared blood supply meant resection could threaten the perfusion of the child’s whole colon. The choice to connect the bowel instead was guided by the anatomy found on imaging and confirmed during surgery.
For families and clinicians, the report also highlights the diagnostic challenge when symptoms that can occur with common childhood constipation persist alongside marked abdominal distention or vomiting. It does not establish that green stools alone indicate an anatomical abnormality, nor does one rare case show that constipation usually signals a serious condition. Its relevance is narrower: the authors stress taking a child’s history seriously and coordinating assessment when symptoms warrant further investigation.
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How Doctors Identified the Duplicate Colon
Alimentary tract duplications are congenital abnormalities that can occur anywhere along the digestive tract, from the mouth to the anus. The case authors cite an estimated frequency of about one in 4,500 births. More than 80% of such duplications present before age two, and the authors say males and females are affected equally.
Duplications involving the colon make up an estimated 13% to 15% of alimentary tract duplications, according to the report. A duplication of the entire colon is much rarer; the authors describe it as an exceptionally rare presentation in infancy and say only a few cases had been reported in the U.K. The report does not provide a population-level estimate for this specific configuration.
The boy’s parents said they had noticed green stools for four to five months and had raised concerns, but were reassured that the color could be normal. In comments reported by MedPage Today, surgeon Lynn Sinitsky said the child had multiple healthcare interactions in which symptoms were attributed to straightforward constipation. The report describes a stepwise specialist assessment, including collaboration with radiology, before the team planned surgery.
““I think our key learning was that he had had multiple interactions with healthcare professionals over his short life, but everyone just attributed it to straightforward constipation without stopping to think, why? Is there something else going on?””
— Lynn Sinitsky, MBBS, of West Hertfordshire Teaching Hospitals NHS Trust, speaking to MedPage Today
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What Follow-Up Cannot Yet Establish
The report offers an encouraging one-year update, but it does not establish the child’s long-term outcome beyond the follow-up described. The authors said they anticipated favorable long-term function based on progress so far; that is an expectation, not a confirmed result over many years. The child still intermittently needed stool softeners, according to the report.
The case also cannot show how often persistent constipation or green stools indicate a rare anatomical condition. The report describes one infant, and the available material does not state whether earlier testing would have changed the course of care. The authors characterize complete colonic duplication as rare and diagnostically challenging, but provide no new population data on its frequency.
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Monitoring Bowel Function Over Time
The case report says the child continued to have a normal bowel habit at the time of follow-up, with occasional use of stool softeners. Ongoing clinical monitoring will be needed to establish whether bowel function, growth and appetite remain stable as he gets older; the report does not specify a future testing schedule.
For clinicians, Sinitsky’s comments point to careful review of the full symptom history and collaboration with specialist teams when an infant has significant distention or other persistent concerns. The report is a case study rather than a change in clinical guidance, and it does not recommend investigation for every child with constipation.
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Key Questions
What did doctors find during the infant’s assessment?
Imaging and surgery showed a duplicated colon and rectum: two colonic channels descended toward one anal canal. The report said imaging did not show other anomalies.
Why did surgeons connect the colons instead of removing one?
The duplicated and native colons shared a wall and a single mesenteric blood supply. The report’s authors said removing the duplicated colon could have jeopardized blood flow to the remaining bowel, so surgeons divided the shared wall to connect the two sections.
How did the child recover?
He tolerated feeds and was discharged on the seventh day after surgery. The ileostomy was reversed 10 weeks after the operation. At one-year follow-up, the report said he had a normal bowel habit and sometimes used stool softeners.
Do green stools or constipation usually mean a child has a duplicated colon?
No. This is a report of one rare case, and it does not show that green stools or constipation usually indicate a duplication. The parents reported green stools over several months, but the case cannot establish that this symptom alone predicts an anatomical condition.
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