8
3
2
-5, 8
Case Report
with many series reported in literatures,
ho9 wever
other workers have reported no sex predil1e0ction, while
others found female: male ration of 9:4. Patients may
present with abdominal pain, this was observed with
difficulties in our patient as he was having intermittent
cry which may be due to abdominal pain. Vomiting was
one of the main presenting symptoms in our patient,
together with abdominal distention and palpable mass in
the abdomen. These presentations were in conson2a,n3c, 5e,
with other reports especially from Ile Ife and Ilorin.
A.Y.U., a three week old male neonate presented to the
Special Care Baby Unit of the Federal Medical Centre
Yola on 18 June 2011 with abdominal distention, fever,
vomiting and constipation for a week. Child had passed
meconium within the first 24 hours of delivery. The an-
tenatal history of the mother suggested no evidence of
polyhydramnous, diabetes or hypertension. Delivery
was at term attended by traditional birth attendant
th
8
(
TBA) but was uneventful. Upon examination, the sig-
The index patient also had fever, which may be as a
o
nificant findings were fever with temperature 38.5 C,
the weight was 3.25 kg, the abdomen was uniformly
distended with a mass measuring about 6 cm х 6 cm in
the right flank with hyperactive bowel sound. A pre-
sumptive diagnosis of intususception with sepsis was
made.
result of sepsis being one of the complications of intesti-
8
nal obstruction because of bacterial translocation. Diag-
nosis of ED is rarely made on clinical ground until sur-5
gery because of non specificity of symptoms and signs.
The index patient had localized type of ceacal duplica-
tion which may explain why there were no other con-
genital abnormalities especially of the 2skeletal system
found on plain radiograph or ultrasound.
Plain abdominal radiography showed distended bowel
loops with no air-fluid levels, but abdominal ultrasound
scan was reported as normal. Blood culture yielded no
bacterial growth. Complete blood count, differentials
counts, Serum electrolytes and urea were within normal
limits. The patient was commenced on antibiotics for
presumed sepsis. Temperature became normal within
three days of treatment, but there was no significant im-
provement with abdominal distention. On the fifth day
abdominal distention worsened with visible peristaltic
waves from right to left across the lower abdomen. Ten
days into admission patient was optimized for explora-
tory laparatomy, which showed duplication of the
caecum (Fig 1). Limited excision and ileo-ascending
colic anastomosis was done, histological examination
confirmed the diagnosis of caecal duplication. Patient
responded to treatment and was discharged on followed-
up.
Never the less other workers within and outside Nigeria
have reported associated malformation which include;
ventricular septal defect, malrotation of the gut, situs
inversus, oesophageal atresis, Down syndrome, imperfo-
rate anus, mesenteric cyst, absence of the lef2t-4r, e8,c1t1us ab-
dominis muscle and short ascending colon.
Ab-
dominal ultrasound in this patient did not show any re-
markable findings, there was a similar experience in
5
Ilorin. The diagnosis was missed on ultrasound may be
because of low index of suspicion, limitation imposed
by overlying bowel gas and probably the technical know
-how of the sonographer. Computerized tomographic
scan (CT scan) and MRI could have been very useful in
establishing the diagnosis, which will show a three-
layered image representing the d,u5plication cyst, com-
2
mon wall and outer bowel wall. These imaging mo-
dalities have helped in making prenatal diagnosis in
some cases.
Fig 1: Cystic duplication of the caecum
However we lack the facilities to carry out these investi-
gations. Laporatomy was carried out and the patient had
limited excision and ileo-ascending colic anastomosis.
Surgical treatment generally is offered to all patients
with ED, the main considerations are the age, lo-5cation,
3
types of lesions and the condition of the patient. Index
patient did well postoperatively and was discharged on
follow-up.
Although rare, enteric duplications do exist in our envi-
ronment and this demand for high index of suspicion
and meticulous management, to avoid patient’s untold
suffering and complications.
Conflict of interest: None
Funding: None
Discussion
The signs and symptoms of ED depend on the size, loca-
tion and the nature of the m5u, 7c,o8sal lining, associated
anomalies and complications.
However, most cases
Acknowledgment
3
r-5e,p7orted in literature present within the first year of life.
Some patient may not be symptomatic until school
We thank the Nursing Staff in the Special Care Baby
Unit, for the care given to the patient.
3
, 5, 8
Our patient is a male which agrees
age or adulthood.