A case report in BMJ Case Reports details an infant who arrived at an emergency department with abdominal distention, vomiting, and constipation. Although the initial suspicion was a partial bowel obstruction, the child was transferred to a specialist pediatric surgical center, where imaging uncovered an exceptionally rare anatomy: a total duplication of the colon and rectum, with two separate colonic lumens descending into a single anal canal.
The authors note that the infant had multiple prior healthcare interactions where symptoms were attributed to straightforward constipation. The parents had repeatedly raised concerns, including persistently green stools for several months, but were reassured those were normal. In hindsight, the researchers say, that sign pointed to an underlying issue.
Because the duplicated colon shared a common wall and a single mesentery with the native colon, removing the duplicate would have endangered the blood supply to the entire colon. Instead, surgeons divided the common wall to join the two colons. The child recovered quickly, was discharged a week after surgery, and had the temporary ileostomy reversed at 10 weeks.
One year later, the child is thriving with normal bowel habits, though intermittent stool softeners are still needed. The authors emphasize that persistent or severe constipation in infants, especially with marked abdominal distention, should prompt a deeper investigation rather than repeated reassurance. They also highlight the value of collaborative, step-wise imaging and multidisciplinary planning in such rare cases.