Gangrenous ileocolic volvulus associated with a communicating terminal ileal duplication in an adolescent boy: a case report

Enteric duplications are uncommon congenital anomalies that usually become symptomatic in infancy or early childhood. Gangrenous ileocolic volvulus associated with a terminal ileal duplication in adolescence is particularly unusual. A 14-year-old boy from rural Ethiopia presented with three days of crampy abdominal pain, bilious vomiting, distension, and obstipation, with localized right-sided peritoneal signs. Radiography showed high-grade distal small-bowel obstruction, prompting emergency exploration. Laparotomy revealed 360-degree ileocolic volvulus involving a communicating terminal ileal duplication, freely mobile cecum and ascending colon, and gangrenous ileocolic bowel. En bloc ileocolic resection was followed by a tension-free, hand-sewn, side-to-side isoperistaltic ileocolic anastomosis. Histopathology confirmed a true enteric duplication. Recovery was uneventful, and the patient remained well at 12 months. Terminal ileal duplication may present beyond early childhood as strangulating ileocolic volvulus. When complete obstruction is accompanied by peritoneal signs, exploration should not be delayed when strangulation or ischemia is suspected.