Rectal duplications

doi:10.1016/0022-3468(90)90242-2

Journal of Pediatric Surgery

Volume 25, Issue 9, September 1990, Pages 980-984

https://doi.org/10.1016/0022-3468(90)90242-2 Get rights and content

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.

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Cited by (87)

Clinical features of colorectal duplication in children: A study of 25 cases
2022, Journal of Pediatric Surgery
Citation Excerpt :
Colorectal duplication (17%) is the second most common alimentary tract duplication after small intestinal duplication [6]. The available literature on colorectal duplication is sparse, at best, and consists mainly of case reports [7–9]. Given the lack of commonly accepted standards for the diagnosis and treatment of colorectal duplication, we attempted to summarize the clinical features of colorectal duplication through a retrospective study with the largest sample size to the best of the authors’ knowledge to provide evidence for clinical practice.
To describe the clinical features and surgical management of pediatric colorectal duplication.
Twenty-five patients with colorectal duplication at Beijing Children's Hospital between January 2010 and December 2020 were reviewed. Colorectal duplications were divided into cystic, diverticular, tubular and mixed types according to shape.
Of the patients, 64% were female, and 44% had accompanying malformations. Abnormal prenatal ultrasound findings (24%), abnormalities immediately found after birth (28%), and postnatal subjective symptoms (48%) were the main clinical presentations. Cystic lesions were observed in 16 patients (64%), including 12 in the colon and 4 in the rectum. Diverticular lesions were observed in 4 patients (16%), and all originated from the sigmoid colon. Among the 4 patients (16%) with tubular lesions, 3 involved the total colon, and the other originated from the splenic flexure to the proximal sigmoid colon. The patient with mixed duplication presented an intact enteric cyst within tubular duplication of the total colon. The mean age at surgery was 20 (0.3–130) months. Except for 4 total colon duplications, complete surgical resection of duplication lesions was performed in all patients. The “distal cross-section, mucosa stripping, and closure” procedure was performed in 3 patients with total colon duplication. Eighteen patients (72%) were followed up for a median time of 54.5 (5–129) months and recovered uneventfully.
Owing to various clinical presentations, colorectal duplication requires careful preoperative differential diagnosis. Complete surgical resection is the preferred radical method for treating cystic, diverticular and short tubular colorectal duplications, except for total colon duplications.
Level IV.
Is the perianal fistula a variation of anal duplication? Case reports and review
2020, Journal of Pediatric Surgery Case Reports
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.
A case report of adult rectal duplication cyst resected by synchronous trans-abdominal and trans-anal total mesorectal excision
2020, International Journal of Surgery Case Reports
Citation Excerpt :
Rectal duplication cyst is rare congenital malformation, and the disease is commonly diagnosed before two years old [1,2].
Rectal duplication cyst is extremely rare. Most of the cases diagnosed before two years old. Adult onset rectal duplication cyst usually contains malignant formation. Then complete tumor resection is needed for the disease to prevent malignant change.
A 52-year-old man was referred to our hospital due to bloody stool. Colonoscopy showed 20-mm of sub-mucosal tumor at low rectum. Biopsy revealed no specific findings. Abdominal computed tomography showed that a 20-mm low density mass at posterior of lower rectum. As the existence of malignant lesion was unassailable, we planned two team, trans abdominal and trans-anal, laparoscopic low anterior resection. Perioperative course was good. Macroscopically, rectum had a submucosal cystic mass fulfilled mucinous content. Histologically, cyst wall was covered with heterotopic ciliated epithelium and composed of smooth muscle.
Trans-anal total mesorectal excision (ta-TME) was introduced as beneficial approach for rectal malignancies.
Complete resection was possible by TME was necessary for patients with adult rectal duplication cyst, and synchronous trans-abdominal and trans-anal approach is a promising option.
Rectal duplication cyst with divarication of recti and urinary retention in a neonate
2019, Medical Journal Armed Forces India
Rectal duplication cyst presenting as rectal prolapse in an infant
2018, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
Yet, less than 100 cases of rectal duplication cysts have been reported in the literature [2,5–8]. The usual clinical presentation of rectal duplication cyst varies from rectal bleeding to infection and fistulization to mass effect symptoms such as tenesmus, constipation or urinary retention [5], however, our case presented as an isolated rectal prolapse which is one of the rarest presentation in this pathology. In such a presentation of retro-rectal cysts, physicians should have few differential diagnoses in their list.
Rectal duplication is a rare variety of gastrointestinal duplication. It accounts 4% of the total gastrointestinal duplications.
In this paper, we are reporting a case of an 8 months old male who presented with rectal prolapse. Digital rectal examination revealed a soft mass bulging through the posterior wall of rectum. Computed tomography (CT) scan showed a cystic mass compressing the posterior wall of the rectum. The mass was excised using a Muscle Complex Saving Posterior Sagittal approach (MCS-PSA). The pathology report confirmed the diagnosis of the rectal duplication cyst. The postoperative recovery was uneventful.
An exceptional presacral mass in children: Rectal duplication
2014, Archives de Pediatrie

View all citing articles on Scopus

^☆: Presented at the 38th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Chicago, Illinois, October 21–23, 1989.

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Rectal duplications☆

Abstract

Zur Kenntniss der an ge Bornen Sacralgesch Ulste

Virchows Arch [A]

Surgical management of precoccygeal cysts

Surg Gynecol Obstet

Retrorectal tumors

JAMA

Myoepithelial hamartoma of the rectum

Dis Colon Rectum

Retrorectal cyst-hamartoma

Am J Surg Pathol

Surgical treatment of duplication of the alimentary tract: Enterogenous cysts, enteric cysts, or ileum duplex

Surg Gynecol Obstet

Duplication anomalies of the rectal

Ann Surg

Duplication of the primitive hindgut of the human being

Surgery

Duplication of the primitive hindgut of the human being: An 8 year follow-up of a previous case report

Surgery

Duplication of the rectum

Am J Dis Child

Enterogenous cysts (Report of case involving the rectum)

Ann Surg