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- Title
Anal duplication: is surgery indicated? A report of three cases and review of the literature.
- Authors
Trecartin, A. C.; Peña, A.; Lovell, M.; Bruny, J.; Mueller, C.; Urquidi, M.; Bischoff, Andrea
- Abstract
<bold>Aim Of the Study: </bold>Anal canal duplications (ACDs) are extremely rare with only approximately 90 cases described in the literature. We report on three additional patients.<bold>Methods: </bold>Cases were analyzed to evaluate presenting symptoms, physical exam and MRI findings. A comprehensive literature review was performed to compare our patients to previously described cases. IRB approval was obtained for this study (19-0394).<bold>Main Results: </bold>The first female patient presented with an asymptomatic ACD at 2 years old. The second patient was a 13-year-old female with perianal drainage that was initially mistaken for a fistula-in-ano and ultimately found to have an ACD associated with a dermoid cyst. Both posterior midline duplications shared a common wall with the rectum, but did not communicate with it. The ACDs and dermoid cyst were successfully excised through a posterior sagittal approach with no postoperative complications. Histology demonstrated the presence of both squamous epithelium and transitional anal epithelium in each case. The third patient was 8 months old and had a tethered cord, hemisacrum, presacral mass, and anal duplication that was initially undiagnosed. These results corroborate patterns identified in other reports of ACDs with over 90% being female and in the posterior midline. The majority are asymptomatic, but may present with symptoms of local or even systemic infection.<bold>Conclusion: </bold>An opening in the midline posterior to the anus should raise clinical suspicion for anal canal duplication. An associated presacral mass must be ruled out. Complete excision through a posterior sagittal approach is recommended upon diagnosis to avoid symptomatic presentations. The key part of the operation is the separation of the ACD from the posterior rectal wall.
- Subjects
LITERATURE reviews; ANUS; DERMOID cysts; SURGICAL complications; WOMEN patients; RECTUM
- Publication
Pediatric Surgery International, 2019, Vol 35, Issue 9, p971
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-019-04509-x