Acute intestinal bleeding due to enteric duplication cyst (EDC) and visceral malrotation in a young male adult: A case report.

Enteric duplication cysts (EDCs) are rare congenital abnormalities of the digestive tract. They may occur with different clinical presentations-including acute intestinal obstruction, perforation or bleeding. The aim of this educational case report is to present the diagnostic and therapeutic process of a young male patient admitted for intestinal bleeding. The peculiarity of this case lies in the association between a rare pathology, EDC, and an equally unusual anatomical condition such as intestinal malrotation. A 27-year-old Italian Caucasian man was admitted with diarrhea and currant jelly stool. No gastrointestinal disorders or previous history of bleeding or chronic abdominal pain were reported. He denied habitual use of nonsteroidal anti-inflammatory drugs (NSAIDs), or other enterotoxic drugs. A small bowel CT scan showed a suspected acute enteritis. A more careful analysis revealed radiological signs of intestinal malrotation. An endoscopic video-capsule could not clearly identify the source of bleeding. The device-assisted enteroscopy revealed, at the mid-distal jejunal level, a double intestinal lumen with traces of digested blood material. The patient successfully underwent a surgical definitive treatment of the jejunal duplication cyst, and was soon discharged. The combination of multiple diagnostic tools, both radiological and endoscopic (entero-CT scan, small bowel video-capsule, and finally device-assisted enteroscopy), allowed for a multidisciplinary approach that led to the diagnosis of a rare small intestinal duplication cyst in a young male patient with congenital intestinal malrotation.