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Rectal duplications
M P La Quaglia1, N Feins, A Eraklis
1Department of Surgery, Children's Hospital Medical Center, Boston, MA.
Insights
Rectal duplications are rare congenital anomalies often misdiagnosed as common anorectal conditions, delaying treatment. Surgical excision, regardless of approach, offers a curative solution with normal postoperative continence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Rectal duplications are rare congenital anomalies.
- They are frequently misdiagnosed as hemorrhoids or fistula-in-ano, leading to delayed diagnosis and treatment.
- This can result in complications such as infection within the duplication.
Purpose of the Study:
- To review the clinical presentation, diagnostic challenges, and surgical management of rectal duplications.
- To highlight the importance of considering rectal duplication in the differential diagnosis of pediatric anorectal pathology.
- To evaluate the efficacy and outcomes of different surgical approaches.
Main Methods:
- Retrospective review of 11 cases of rectal duplication.
- Analysis of patient demographics, presenting signs and symptoms, diagnostic methods, and surgical interventions.
- Evaluation of postoperative outcomes, including continence.
Main Results:
- Patients presented between newborn and 18 years (mean 17 months).
- Common presentations included perianal/anal fistula (5 cases), obstruction/prolapse (3 cases), and rectal bleeding (3 cases).
- No spinal or vertebral anomalies were noted. All patients achieved normal postoperative continence after total excision via transanal, postanal, or posterior sagittal approaches.
Conclusions:
- Rectal duplications can mimic common anorectal conditions, necessitating a high index of suspicion.
- Early and accurate diagnosis is crucial for timely intervention.
- Total surgical excision using various posterior approaches is curative and preserves normal continence.
Abstract:
Recent experience with two cases of rectal duplication, which had been misdiagnosed as hemorrhoids, or fistula-in-ano with resultant delay in diagnosis, prompted us to review our prior experience with 11 of these unusual cases. Age at presentation ranged from newborn to 18 years (mean, 17 months). The most common presenting sign was a perianal or anal fistula, observed in five children. Two children presenting with fistulae had concomitant infection in the duplication. Other presenting signs included obstruction or prolapse caused by the rectal mass in three patients, rectal bleeding in three, and urinary retention in one. Some children presented with more than one finding. No associated spinal or vertebral anomalies were observed. Total excision was performed using a transanal approach in eight patients, postanal (transcoccygeal) in two, and posterior sagittal in one. Postoperative continence was normal in all patients. These cases illustrate that rectal duplications can be confused with other types of anorectal pathology including hemorrhoids, fistula-in-ano, and perirectal abscess. Total excision performed using a posterior sagittal, transanal, or transcoccygeal approach is curative.