Infected transverse colonic cystic duplication simulating pelvic appendicular abscess.

To cite: Patel RV, Milliken I, Dick A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013201459 DESCRIPTION A 23-month-old girl presented with 5 days of lower abdominal pain, lethargy, anorexia, reduced wet nappies and high fever not responding to a 5-day course of amoxicillin. On examination, she had a pulse rate of 179, respiratory rate 32, temperature 39.2°C and a tender mass in the lower abdomen. A urine dipstick was normal. White cell count was 30.36 × 10/L, neutrophils 24.59× 10/L and C reactive protein 34.9 mg/L. An abdominal ultrasound scan showed a 5.7 cm long cystic mass on the left side of the pelvis with a thin septae, layering of the debris within the mass, haustra-like appearance and enhancing double wall at places, and a small amount of free intraperitoneal fluid in the pelvis, which was later confirmed by a CT scan (figure 1). A giant infected cystic duplication of the mid-transverse colon was diagnosed at surgery via Pfannenstiel incision. She underwent a segmental resection of the transverse colon including the duplicated colon and end-to-end anastomosis uneventfully. Pathology confirmed non-communicating infected colonic duplication cyst and revealed a whole muscle layer of the colon together with inflamed, ulcerated mucosa with extensive granuloma and abscess formation compatible with an infected duplication. Postoperative recovery was uneventful. She is asymptomatic and thriving well at 8-month follow-up. Mid-transverse colonic cystic duplication presenting late with complications of infection and abscess formation in the pelvis is rare. 2 Differential diagnoses include appendicular abscess, infected ovarian cyst, inflammatory pseudocyst or infected mesenteric cyst. Antenatal diagnosis is possible and resection with reconstruction is curative. Transverse colonic surgery via Pfannenstiel incision is a technical challenge.