Small Bowel Obstruction Secondary to an Intestinal Duplication and an Internal Hernia: a Case Report

ABSTRACT Introduction Small bowel duplication has an estimated incidence of 1 in 4,500 live births and is most often diagnosed before two years of age. Internal herniation through the inter-duplicational space is rarely reported in the literature. Case Presentation A 17-year-old male presented with one week of progressively worsening abdominal pain, constipation, nausea, and vomiting. Abdominal radiographs and CT scan were concerning for small bowel obstruction associated with a retained intraluminal foreign body. Exploratory laparotomy identified a 10 cm double-barreled communicating tubular duplication, with the duplicated and native bowel limbs forming two parallel channels with proximal and distal communication. A fenestrated defect between these limbs created an internal hernia aperture, through which approximately 10 cm of adjacent small bowel herniated and became obstructed. A foreign body was also found within the duplicated bowel. The internal hernia was reduced and a segmental small bowel resection was performed with side-to-side stapled anastomosis. The postoperative course was uncomplicated, the patient was discharged on postoperative day two after return of bowel function. Final pathology confirmed the intestinal duplication with mucosal erosion, ischemic changes, and foreign body. The patient remained asymptomatic at three-month follow-up. Conclusion Bowel herniation through a space between a tubular duplication and the native bowel, although extremely rare, should be considered in adolescents presenting with unexplained bowel obstruction