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Published on: November 30, 2010
Optimizing Surgical Techniques for Anal Canal Duplications in 2 Pediatric Patients
Ana Sofia Soto Torselli1,2, Miriam Duci1,2, Maurizia Grazzini1,3
1Department of Women and Children's Health, University of Padova, Padova, Italy.
Insights
Anal canal duplications (ACD) are rare in children over two. Surgical management varies, with imaging guiding techniques for optimal outcomes in these complex pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Anal canal duplications (ACD) are uncommon in children older than two years.
- Symptoms can be nonspecific, and treatment requires tailored surgical approaches.
Purpose of the Study:
- To report two pediatric cases of anal canal duplications with atypical presentations.
- To highlight the importance of imaging in surgical planning for ACD.
Main Methods:
- Case report of two pediatric patients with anal canal duplications.
- Surgical resection using different techniques (posterior approach, robotic-assisted) based on lesion characteristics.
- Radiological imaging (MRI) to delineate lesion location and extent.
Main Results:
- Both patients underwent successful surgical removal of ACD.
- Complete anal sphincter function and recovery were achieved postoperatively.
- Histological analysis confirmed ACD in both cases.
Conclusions:
- ACD should be considered in pediatric patients over two with cystic or infected ischiorectal fossa lesions.
- Radiological imaging is crucial for determining the optimal surgical approach.
- Infected or complicated ACD may necessitate an open posterior approach, while uncomplicated cases may benefit from minimally invasive techniques.
Abstract:
BACKGROUND Anal canal duplications (ACD) are rare in children older than 2 years old. While some patients are asymptomatic, others have a variety of nonspecific symptoms. The definitive treatment is surgical removal, but the best technique varies with each case based on the local situation and the location of the lesion. CASE REPORT We present 2 cases of anal canal duplications in pediatric patients. Despite the atypical presentations of a concomitant cystic, a high suspicion of ACD led to surgical management using different techniques based on its location and local situation. The first patient had a sterile perianal abscess in the ischiorectal fossa, unresponsive to antibiotics and recurrent after surgical drainage. MRI revealed a fistula connecting the cyst to the exterior at the pectineal line, prompting a posterior approach for complete resection of the mass from the rectum. The second patient had an incidentally discovered ischiorectal mass. Imaging suggested a homogeneous cyst adhered to the rectal wall and easily accessible, leading to a successful robotic-assisted surgical resection. Both patients achieved complete anal sphincter function and full recovery postoperatively. Histological analysis in both cases presented typical characteristics found in ACD. CONCLUSIONS Although ACD is rare in pediatric patients over 2 years of age, cystic or infected lesions in the ischiorectal fossa should be considered as differential diagnoses. Radiological imaging is crucial for understanding the cyst's location and determining the optimal surgical approach. As presented in our cases, an open posterior approach may be considered when the lesion is or has been complicated by previous infection, associated with a fistula, as opposed to non-complicated cases in which a mini-invasive approach may be ideal.
