J Korean Assoc Pediatr Surg.  2017 Dec;23(2):55-58. 10.13029/jkaps.2017.23.2.55.

Anterior Anorectocolonic Tubular Duplication Presenting as Rectovestibular Fistula in an Infant

• Kim JY
• Youn JK
• Kim SH
• Kim HY
• Jung SE
• Park KW

• KMID: 2398578
• DOI: http://doi.org/10.13029/jkaps.2017.23.2.55

Abstract

Anorectal duplications account for only 5% of gastrointestinal duplications, and cases with involvement of the anal canal are much rarer. Nearly all anorectal duplications are posterior to the rectum; duplications located anterior to the normal rectum are highly unusual, and only a few cases have been reported. We report the case of an anterior anorectocolonic duplication presenting as a rectovaginal fistula in a 2-month-old infant. After diagnosis, the duplication was excised completely without further intestinal complications.

Keyword

Anal canal duplication; Rectal duplication; Colonic duplication; Duplication; Rectovaginal fistula

MeSH Terms

Anal Canal
Diagnosis
Fistula*
Humans
Infant*
Rectovaginal Fistula
Rectum

Figure

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  Fig. 1 A preoperative colon study appeared to show that the contrast had passed to the vagina through a rectovaginal fistula (arrows).

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  Fig. 2 Examination under general anesthesia revealed a normal anus, an anterior anorectal duplication (catheter-inserted state), and duplicate vaginal openings.

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  Fig. 3 Intraoperative findings. (A) The intraoperative contrast study revealed that the contrast injected via the anterior anorectal duplication filled the normal colon and rectum and that there was a connection between the duplication and the normal colon at the level of the proximal sigmoid colon. (B) Intraoperative sigmoidoscopy at the merging point revealed that a catheter inserted via the anterior anorectal duplication could be observed by a scope inserted via the normal anus.

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  Fig. 4 Operative findings. (A) The tubular anorectocolonic duplication and the normal anorectum were dissected from neighboring structures. (B) Resected specimen.

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  Fig. 5 Schematic diagram of surgical findings.

Reference

1. Narci A, Dilek FH, Cetinkurşun S. Anal canal duplication. Eur J Pediatr. 2010; 169:633–635.

2. Stern LE, Warner BW. Gastrointestinal duplications. Semin Pediatr Surg. 2000; 9:135–140.

3. Prasil P, Nguyen LT, Laberge JM. Delayed presentation of a congenital recto-vaginal fistula associated with a recto-sigmoid tubular duplication and spinal cord and vertebral anomalies. J Pediatr Surg. 2000; 35:733–735.

4. Knudtson J, Jackson R, Grewal H. Rectal duplication. J Pediatr Surg. 2003; 38:1119–1120.

5. Hernandez Troya AC, Gebara S, Bloom DA, Chan W. Occult colonic duplication. Clin Pediatr (Phila). 2011; 50:550–552.

6. Zhang Z, Huang Y, Wang D, Su P. Rectosigmoid tubular duplication presenting as perineal sepsis in a neonate. J Pediatr Surg. 2010; 45:627–629.

7. Amjadi K, Poenaru D, Soboleski D, Hurlbut D, Kamal I. Anterior rectal duplication: a diagnostic challenge. J Pediatr Surg. 2000; 35:613–614.

8. Macpherson RI. Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics. 1993; 13:1063–1080.

9. Kratz JR, Deshpande V, Ryan DP, Goldstein AM. Anal canal duplication associated with presacral cyst. J Pediatr Surg. 2008; 43:1749–1752.

10. Parvaiz A, Stevens RJ, Lamparelli MJ, Jeffery PJ. A rare case of adenocarcinoma arising within a duplication cyst of the rectum: curative excision with 9-year follow-up. Ann R Coll Surg Engl. 2005; 87:W8–w10.