Anal Canal Duplication Research Articles

Novel approach to a rare communicating anal canal duplication in an 11-month-old female: A case report

Novel approach to a rare communicating anal canal duplication in an 11-month-old female: A case report

Cystic lesions of the retrorectal space.

Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.

Anal Canal Duplication Mimicking Recurrent Abscess: A Case Report and Review of the Literature.

BackgroundAnal canal duplication (ACD) is a very rare duplication of the gastrointestinal tract and is described as a secondary anal orifice along the posterior side of the normal anal canal. Early surgical removal is advisable, also in asymptomatic patients, because of the risk of inflammatory complications, such as recurrent crissum abscess, and malignant changes.Case presentationA previously healthy 2-year-old boy was evaluated in the emergency department with fever. He complained of anal pain in the absence of incentive. Physical examination and ultrasound confirmed a diagnosis of perianal abscess. He was treated with incision and drainage of the abscess and intravenous antibiotics. Two months after his discharge from the hospital, he developed fever and had intervals discharge pus and pain in the same locations. Colorectal endoscopy revealed that there was no fistula opening at the rectal wall. Intraoperative fistulography showed a fistulous tract that was connected to a subcutaneous cavity. Excision of the fistulous tract and wide drainage of the deep postanal space were performed. The patient was referred to our hospital for further evaluation 6 months later. Physical examination showed a secondary anus that had not been noticed before. MRI showed an anal fistula between 1 and 3 o’clock, and preoperative fistulography revealed a 3-cm-long tubular structure without any connection with the rectum. The diagnosis of ACD was made by intraoperative examination with a metal catheter and the postoperative pathological analysis. The duplicated anal canal was resected completely via a perianal approach without any rectal injury. Histology showed a squamous epithelium in the distal end with some smooth-muscle fibers. After a follow-up of 8 months, the patient has been doing well.ConclusionRecurrent crissum abscess should raise clinical attention to alimentary tract congenital malformations such as ACD. Prompt recognition of these unique presentations of ACD is needed, and complete excision through a perineal approach or posterior sagittal approach is recommended.

Currarino triad with a duplicate anal canal presenting with an infected sacral mass

Currarino syndrome is a rare congenital malformation characterised by the triad of: an anorectal malformation, sacral bony defect and presacral mass. One rare but possible anorectal malformation is an anal canal duplication, a congenital anomaly which is not only the most distal but also the rarest form of digestive tract duplication. We present the case of a four-year-old female who had a complete form of the Currarino triad including an anal canal duplication.

Sacrococcygeal teratoma Type IV presenting as anal canal duplication: Lessons learned

We present an extremely rare association of anal canal duplication with sacrococcygeal teratoma Altman's Type IV. A 3-year-old female child presented with anal discharge, itching, and vague perineal pain. On examination, a small second opening of 5 mm in size and 2.5 cm in length was located just posterior to the normal anus at 6 'o'clock position. The lumen ended blindly without connection to the normal anorectum. Ultrasound and radiological investigations were normal. During excision of the duplicated tract, it was seen arising from a presacral mass which was completely excised along with coccygectomy. Biopsy was confirmed mature teratoma and anal canal duplication.

The Controversy of Surgical Intervention for Anal Canal Duplication in Children.

Objective:Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings.Methods:A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications.Results:All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention.Conclusion:Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary.

Is the perianal fistula a variation of anal duplication? Case reports and review

Abstract Anorectal malformations are birth defects which include a wide range of diseases. With this defect, the anus and rectum don't develop properly. They can involve both genders. The involved organs in such malformations are anus, rectum, urinary and genital systems. The defects vary from very easy to very difficult curable. The incidence of these birth defects is about 1 in 5000 live births. On the other hand, perianal fistula and abscess formation are common perianal disease in children. The symptoms of perianal fistula are: secretion in the perianal area, pruritus and bleeding. Among alimentary tract duplications, anal canal duplication is the rarest and the more distal one, which has been defined as duplication along the posterior side of the anal canal, with a perineal orifice located behind the anus at 6 o'clock position and its physical aspect is duplicated anus. In this study, three cases were reported with anal duplication presenting a condition similar to perianal fistula. Reviewing these cases guide us to a new horizon that some fistulas or abscess formation in early age or in infancy might be a complication of underlying anal duplication. The proposed management for perianal fistula is fistulectomy.

Mucosal stripping and muscular layer quilting in the treatment of anal canal duplication: Operative technique

Anal canal duplication (ACD) is the least frequent digestive duplication [1]. It presents as a perineal orifice that ends with a tract along the anal canal [2]. Symptoms are often absent but can occur or worsen with age. Surgical excision of the duplicated anus is required because of the risk of infection and malignancy [3]. Here we present a patient with ACD that was treated with a technique that we pioneered called mucosal stripping and muscular layer quilting (MSMQ). This technique was performed for the first time in our clinic 11 years ago on 2 patients and has been described in a case report [4]. We describe the surgical technique here using a case presentation with photographs that illustrate the technique.

Recurrence of anal canal duplication with abscess formation

Abstract Anal canal duplication, a rare congenital disease, is often noticed in fistulas behind the native anus and is sometimes accompanied by abscesses and cysts. The perineal approach and posterior sagittal approach are considered surgical options. A 6-year-old girl with anal canal duplication with abscess formation underwent surgery using the perineal approach but experienced relapse. The foci were completely removed using a posterior sagittal approach, and her condition was cured completely. To prevent the risk of abscess formation, fistulation, and malignancy, it is important to completely remove the fistula/abscess cavity using the posterior sagittal approach during the first treatment or by switching from the perineal approach to the posterior sagittal approach when necessary.

Anal Canal Duplication in a 40-Year-Old Adult

Anal canal duplication (ACD) is the rarest congenital malformation of the digestive tract and is associated with other congenital malformations. The clinical case reports a 40 years old woman who had two episodes of anal abscesses treated with surgical drainage within 1 year. In proctology consultation, the examination revealed a structure in the midline, posterior to the native anus. Pelvic magnetic resonance imaging and anal echoendoscopy confirmed the presence of a tubular structure posterior to the anal canal, compatible with duplication of the anal canal. The patient was proposed for surgical excision but refused. Seven years later, the patient had another anal abscess. She was again proposed for surgery and refused. Around 60 cases of ACD are currently described worldwide. The diagnosis is usually made at an early stage of life. Our patient was diagnosed at the age of 40 years, constituting one of the most elderly patient diagnosed with ACD. J Med Cases. 2018;9(2):61-63 doi: https://doi.org/10.14740/jmc2902w

Residual Abscess of Anal Canal Duplication Developing in Adulthood: A Case Report

Residual Abscess of Anal Canal Duplication Developing in Adulthood: A Case Report

Anal canal duplication and triplication: a rare entity with different presentations

Anal canal duplication (ACD) is the rarest of gastrointestinal duplications. Few cases have been reported. Most cases present as an opening in the midline, posterior to the normal anus. The aim of our revision is to contribute with eight new cases, some of them with unusual presentations: five presented as the typical form, one with a perianal nodule, and two presented as two separate orifices (anal canal triplication). Complete excision was performed in all patients with no complications. ACD is the most distal and the least frequent digestive duplication. Its treatment should be surgical excision, to avoid complications such as abscess, fistulization, or malignization. Anal canal triplication has never been described before.

Anal canal duplication presenting with abscess formation

Anal canal duplication presenting with abscess formation

Anal canal duplication associated with presacral teratoma in a 5-year old girl

Abstract This report describes an extremely rare case of anal canal duplication associated with presacral teratoma in a 5-year-old girl who presented with perineal pain and constipation. Abdominopelvic computed tomography (CT) revealed a multiloculated heterogeneous mass measuring 5 cm in the presacral area. T2-weighted magnetic resonance imaging (MRI) showed a 4.5-cm sized multilocular cystic lesion with high signal intensity. The mass was surgically removed with coccyx. Histologically, the tumor showed components of bronchial and gastrointestinal mucosa, squamous epithelium, cartilage, fibrofatty tissue, and some exocrine glands. The histopathological diagnosis was mature teratoma. Eight months after surgery, the patient is doing well, with no recurrence of tumor.

Anal Canal Duplication in Adults: Report of Five Cases

Anal canal duplications are very rare noncommunicating second anal orifices located posterior to the true anus. In this study, 5 adult cases of anal canal duplication are reported as extremely rare entities in the literature. The medical records of anal canal duplication patients treated from 2011 to 2014 were reviewed retrospectively. Five adult patients with symptoms of mucous discharge, anal pain, and or perianal fistula/abscess were admitted. Findings of physical examination and radiologic imaging (pelvic magnetic resonance, endoanal ultrasound, and or colonoscopy) suggested anal canal duplication. The mean age of patients was 40.4 ± 8.7 (range, 33–55), and the mean follow-up period was 18.4 ± 11.2 (range, 6–36) months. Histologic features of the removed samples confirmed anal canal duplication. All patients underwent complete surgical excision of the rudimentary anal canal. Anal canal duplication is a very rare congenital anomaly, and 5 additional adult cases are reported. Although this is a referral center, the recent accumulation of 5 adult cases of anal canal duplication suggests that this malformation might be more prevalent and frequently overlooked.

Fetal growth of the anal sinus and sphincters, especially in relation to anal anomalies.

The anal sinuses, small furrows above the pectinate line, sometimes form perianal abscesses in adults. We examined the pattern of fetal growth of the anal sinus and sphincters using 22 mid-term (8-18 weeks) and 6 late-stage (30-38 weeks) fetuses. In mid-term fetuses, the external and internal sphincters gradually increased in thickness, depending on specimen size (from 0.2 to 1.5 mm), whereas the anteroposterior diameter of the anal canal at the epithelial junction was relatively stable (0.5-1.0 mm) irrespective of specimen size. Anal canal diameter increased less than twofold between mid-term and late-stage fetuses, from 0.5-1.0 to almost 2 mm, whereas sphincter thickness increased over tenfold, from 0.2-1.5 to almost 3.5 mm. The anal sinus often showed balloon-like enlargement when the sphincter muscle bundles were tightly packed in mid-term, but not in late-stage fetuses. Large concentric mechanical stress from the sphincters in late-stage fetuses apparently prevented the anal sinus from expanding in a balloon-like manner. Conversely, to avoid anal stenosis, the growing sinuses maintained a luminal space of the anal canal in response to stress from rapidly growing sphincters. The inferiorly extending sinus usually provided temporal double canals separated by a thick column. In the presence of double lumens, anal canal duplication is likely to develop without any abnormalities of the anal epithelium and sphincters.

Late presentation of anal canal duplication in adults: a series of four rare cases.

Anal canal duplication (ACD) is a very rare condition, especially in adults. Four cases in adults are reported. In three cases, the orifice of duplication was located behind the native anus, and in one case, it was located anteriorly. In all cases, no communication between the anal canal and the tract of duplication was noted. Complete removals of the duplications were done through a perineal approach. Histology showed fibro-muscular tissue lined with a squamous epithelium. The postoperative courses were uneventful.

Anal canal duplication: Case report and literature review

Anal kanal duplikasyonu (AKD) nadir bir gastrointes- tinal anomalidir. Biz burada yeni bir olgu sunumu esliginde literaturde ki AKD hastalarini klinik ozellik- ler, tani ve tedavi yaklasimlari acisindan gozden gecirmeyi amacladik. Anal canal duplication (ACD) is a rarely seen gastroin- testinal anomaly. We aimed to review the clinical features, diagnostic assessment and treatment app- roach in ACD patients in association with a case pre- sented by us.

Anal canal duplication in an 11-year-old-child.

Anal canal duplication (ACD) is the least frequent digestive duplication. Symptoms are often absent but tend to increase with age. Recognition is, however, important as almost half of the patients with ACD have concomitant malformations. We present the clinical history of an eleven-year-old girl with ACD followed by a review of symptoms, diagnosis, treatment, and prognosis based on all the reported cases in English literature.

Late presentation of anal canal duplication in an adolescent female—a rare diagnosis

Late presentation of anal canal duplication in an adolescent female—a rare diagnosis