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Case of an adult tubular sigmoid duplication with associated vascular and urological abnormality

Gastrointestinal duplication is an uncommon congenital condition that usually presents in the paediatric population and found most frequently in the small bowel. Adult colonic duplications are even rarer, and often masquerade as a variety of conditions making diagnosis and management difficult. We report a unique case of tubular sigmoid duplication in an adult male with bilateral triplication of pelvi-calyceal systems who presented with recurrent urinary tract infection, necrotizing scrotal abscesses and incidental rectal mass on digital rectal examination. This is the first reported case with an associated vascular anomaly. Computed tomography (CT) scan identified the distal sigmoid colonic segment to have dual lumens running in parallel. The distended medial colonic lumen was fecal-laden, with a blind-ending distal end compressing the rectum which corresponded to the anterior rectal mass palpated (Fig. 1a,b). Colonoscopy was not performed because of the expected difficulty with the impacted faeces in the duplicated colonic segment. Interestingly, there was an associated anomalous vascular anatomy (Fig. 1c) of an absent right common iliac artery and a persistent single aberrant umbilical artery, otherwise called a patent impar umbilical artery (IUA), which reconstituted with a slender right-sided artery from proximal abdominal aorta to form the right external iliac artery. The IUA was the larger left ‘branch’ of the aorta, which included a large crossover artery coursing extra-peritoneally. The slender rightsided aortic ‘branch’ was actually the distal aorta. Open anterior resection was offered for the duplicated colon because this limb could not be evaluated in the future for malignant change and the pelvic mass is a contributory factor for the recurrent urinary tract infection in the patient. During the lower midline incision, the crossover artery from the left was carefully identified and