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Wang K, Yang L, Peng C, Pang W, Wang Z, Zhang D, Wu D, Chen Y. Caudal duplication syndrome: 10-year experiences with a comprehensive literature review. Pediatr Surg Int 2022; 38:1283-1289. [PMID: 35780394 DOI: 10.1007/s00383-022-05159-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Caudal duplication syndrome (CDS) has rarely been reported. The purpose was to describe the characteristics and discuss possible pathogenesis of CDS by reviewing our experience along with a comprehensive literature review. METHODS A total of 51 patients including 3 from our team and 48 from literature were selected in this study. General condition, clinical manifestations, type of anomalies, treatment and prognosis was analyzed and summarized. RESULTS Among the 51 patients were 30 females and 21 males, and age at first clinical visit was from birth to 39 years old. Except 12 patients, most of the patients had no troubling clinical manifestation. Physical examination showed that 30 patients had 1 perineum, 21 patients had 2 completely independent perineums. Degree of duplication varied; colon-rectum tubular, bladders and urethras, vaginas in females and penis shafts and glans in males were found to be the most common type of alimentary system and urogenital system duplication in this study with 24/51, 41/51, 10/30 and 16/21 patients, respectively. Anorectal malformation was calculated: 18 had 2 ARMs, 14 had 1 normal anus and 1 ARM on the other side, 12 had a normal anus, 5 had 2 normal anus, the remaining 2 patients had only 1 ARM. Spinal cord anomalies were showed as meningomyeloceles and lipomas in 13 and 3 patients. Vertebral anomalies of bifid, dysplasias, scoliosis, and hemivertebra were noticed in 28 patients and accessory dysplasia lower limbs were found in 10 patients. Prognosis showed 39 of the 51 patients had normal function in urination and defecation. CONCLUSIONS CDS is an extremely rare disease with uncertain pathogenesis. Colon-rectum tubular duplication with two ARMs, duplicated bladders and urethras, double vaginas in females and penis shafts and glans in males are the most common type. Long-term prognosis is good with multidisciplinary, individualized and staged surgical procedures.
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Affiliation(s)
- Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Liucheng Yang
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangdong, 510282, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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Cohen N, Ahmed MN, Goldfischer R, Zaghloul N. Persistent cloaca and caudal duplication in a monovular twin, a rare case report. Int J Surg Case Rep 2019; 60:137-140. [PMID: 31220683 PMCID: PMC6584906 DOI: 10.1016/j.ijscr.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION A cloaca occurs when genitourinary tract and bowel converge into a common channel. We report a case of partial caudal duplication, persistent cloaca and vestigial appendage in a monovular female twin infant. PRESENTATION OF CASE This is a monochorinonic-diamniotic twin born at 36 weeks with apgars of 9/9. She had a duplicated labia with two clitorises, and a partially formed accessory foot with 2 toes protruding from the right gluteal region. There was anal atresia and a punctate urethral opening in the right genitalia through which she voided spontaneously. X-ray of the accessory foot had rudimentary metatarsals and phalanges. There was left hydroureteronephrosis and a hydrocolpos causing severe mass effect. On the first day of life, she had exploratory laparotomy with a diverting colostomy and mucus fistula and drainage of hydrocolpos. At 6 months of age, she had removal of the accessory foot with flap closure of the perineal defect and vesicostomy. At 15 months of age she had laparotomy for repair of cloaca, excision of presacral pelvic mass and the duplicated vulva. DISCUSSION Theories of etiology include failure of regression of Kovalevsky's canal (a communication that connects the amniotic and yolk sac), an incomplete form of twinning through iatrogenic damage to the zona pellucida or a failed triplet formation from a single embryo. CONCLUSION Caudal duplication with persistent cloaca and vestigial appendage is a rare and complex malformation. Having a unified surgical and medical team to preserve quality of life and to treat complications is of key importance.
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Affiliation(s)
- Naomi Cohen
- Department of Pediatrics, Division of Neonatology, Cohen’s Children’s Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Mohamed Nagy Ahmed
- Department of Pediatrics, Division of Neonatology, Cohen’s Children’s Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Rachelle Goldfischer
- Department of Radiology, Cohen’s Children’s Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Nahla Zaghloul
- Department of Pediatrics, Division of Neonatology, Cohen’s Children’s Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY 11040, USA,Corresponding author at: Division of Neonatology, Department of Pediatrics, Diamond Children's Medical Center, Steele Children’s Research Center, University of Arizona College of Medicine, P.O. Box 245073, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
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Nikièma Z, Kouamé N, Dakouré PWH, Traoré C, Rabiou R. Dipygus: Computed tomography findings and management. Diagn Interv Imaging 2015; 96:1219-21. [PMID: 25791018 DOI: 10.1016/j.diii.2013.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/04/2013] [Accepted: 04/11/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Z Nikièma
- Service d'imagerie médicale, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso 01, Burkina Faso.
| | - N Kouamé
- Service de radiologie, CHU de Yopougon, 21 BP 632, Abidjan 21, Cote d'Ivoire
| | - P W H Dakouré
- Service de traumatologie et d'orthopédie, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso 01, Burkina Faso
| | - C Traoré
- Service de neurochirurgie, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso 01, Burkina Faso
| | - R Rabiou
- Service d'imagerie médicale, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso
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Arnone K, Cloutier J, Bolduc S. Persistent cloaca and partial caudal duplication: a case report. Urology 2011; 78:431-3. [PMID: 21296396 DOI: 10.1016/j.urology.2010.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/05/2010] [Accepted: 11/05/2010] [Indexed: 11/17/2022]
Abstract
Persistent cloaca and caudal duplication are 2 rare anomalies of embryogenesis that can present with a wide variety of pelvic malformations. Here we present the rare case of a female born with both abnormalities. The infant was born with a single introitus, an imperforate anus, a didelphys uterus, a duplicated cervix and vagina, and accessory limb and coccyx. Multiple surgeries were performed to correct for the anomalies that would have otherwise had important health and lifestyle consequences for the child.
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Affiliation(s)
- Krystina Arnone
- Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Canada
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Alberio N, Pentimalli L, Alessandrello R, Lipani R, Maiello M, Morabito A, Spitaleri A, Zambuto MR, Soma P, Francaviglia N. An exceptional case of complete lumbosacral spine duplication and open myelomeningocele in adulthood. J Neurosurg Spine 2010; 13:659-61. [PMID: 21039160 DOI: 10.3171/2010.5.spine08962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a 47-year-old woman with a wide (14 × 12-cm) ulcerated lumbosacral myelomeningocele. The patient had sought medical attention for a sudden copious CSF leak from the lumbosacral sac followed by clinical signs of CSF leakage. After admission, neuroradiological assessment (spinal MR and 3D CT imaging) revealed the uncommon finding of a complex malformation characterized by a complete spine duplication originating at the L2-3 level, both hemicords having a separate dural sac. The myelomeningocele sac originated medially at the L-2 level. Surgical repair of the lumbosacral myelomeningocele was performed. The placement of a ventriculoperitoneal shunt became necessary to treat secondary hydrocephalus. After reviewing accredited classifications on spinal cord malformations, the authors believe that, to date, complete duplication and separation of the spine and dural sac seems exceptional, and its report in adulthood appears exceedingly rare.
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Affiliation(s)
- Nicola Alberio
- Department of Neurosurgery, S. Elia General Hospital, Caltanissetta, Catania, Italy
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Halidou Doudou M, Hallarou M, Tambary M, Harakoye A, Manzo M, Adamou H. La pygomélie : à propos d’un cas opéré au Niger. Arch Pediatr 2008; 15:1426-9. [DOI: 10.1016/j.arcped.2008.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 03/17/2008] [Accepted: 06/20/2008] [Indexed: 12/01/2022]
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Corona-Rivera JR, Corona-Rivera E, Franco-Topete R, Acosta-León J, Aguila-Dueñas V, Corona-Rivera A. Atypical parasitic ischiopagus conjoined twins. J Pediatr Surg 2003; 38:e3. [PMID: 12596123 DOI: 10.1053/jpsu.2003.50063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Occurrence of asymmetrical or parasitic conjoined twins (CT) is rare, and currently they are classified analogically to the common unions of symmetrical CT. The authors report on an infant with a parasitic third limb attached to the left lateral aspect of the autosite trunk, in whom male gonadal tissue was found histologically. Parasite parts included complete left lower limb, hemipelvis, lumbosacral vertebral column, spinal cord, and one kidney with ureter and adrenal gland. Autosite anomalies comprised a small left diaphragmatic defect, omphalocele, exstrophy of cloaca, and lumbar meningomyelocele. The authors considered this case to be a rare atypical parasitic ischiopagus CT. The differential diagnosis of the type of twining and other entities with caudal duplications is analyzed briefly.
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Affiliation(s)
- J Román Corona-Rivera
- Laboratorio de Genética Humana y Clínica de Asesoramiento Genético, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., México
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Herman TE, Siegel MJ. Special imaging casebook. Dipygus or pygomelia. J Perinatol 2001; 21:266-7. [PMID: 11533848 DOI: 10.1038/sj.jp.7200309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/1999] [Accepted: 08/23/1999] [Indexed: 11/09/2022]
Affiliation(s)
- T E Herman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Bannykh SI, Bannykh GI, Mannino FL, Jones KL, Hansen L, Benirschke K, Masliah E. Partial caudal duplication in a newborn associated with meningomyelocele and complex heart anomaly. TERATOLOGY 2001; 63:94-9. [PMID: 11241432 DOI: 10.1002/1096-9926(200102)63:2<94::aid-tera1015>3.0.co;2-a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Caudal duplication is a spectrum of rare congenital anomalies with a possible heterogeneous pathogenesis including incomplete separation of monovular twins. METHODS We report an autopsy case of a full-term infant with incomplete caudal duplication syndrome associated with multiple anomalies. RESULTS These anomalies included a duplicated penis; double urinary bladder with an attenuated tunica muscularis; duplication of lower bowel with two ilia, appendices and colons; colonic hypogangliosis and left imperforated anus associated with rectourethral fistula. Other anomalies consisted of sacral meningomyelocele, sacral duplication with hypoplastic left sacrum and pelvic bones, muscle atrophy and hypoplasia of the left lower extremity, abnormal lobation of liver with stomach entrapment, omphalocele, and right atrial isomerism syndrome. The complex pattern of anomalies suggests the possibility that partial caudal duplication might be part of the spectrum of conjoined twinning.
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Affiliation(s)
- S I Bannykh
- Department of Pathology, University of California, San Diego Medical Center, San Diego, California 92103-8321, USA
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Otiang'a-Owiti GE, Oduor-Okelo D, Kamau GK, Makori N, Hendrickx AG. Morphology of a six-legged goat with duplication of the intestinal, lower urinary, and genital tracts. Anat Rec (Hoboken) 1997; 247:432-8. [PMID: 9066922 DOI: 10.1002/(sici)1097-0185(199703)247:3<432::aid-ar16>3.0.co;2-q] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND An adult female goat with rare malformations, which consisted of duplication of the intestinal, lower urinary, and genital tracts as well a pair of parasitic appendages, is presented. METHODS A complete dissection was performed on a moribund female goat (Capra hircus). RESULTS The animal had a normal body with a parasitic attachment located within the pelvic region. This attachment was represented by an ovoid, trunk-like, adipose mass that lacked internal organs or vertebrae but that had two fairly well-developed limbs with the normal components of hind limbs. There was duplication involving the external and internal genitalia, the urethra, the urinary bladder, and portions of the small intestine as well as the large bowel, including the anal openings. CONCLUSIONS An autosite with a duplication involving the hindgut and paramesonephric anlages was identified. These features were compatible with life in utero and postutero and emanated from incomplete twinning (heteropagus twins). A review of the literature also suggests that heteropagus twins are a very rare abnormality in both domestic animals and humans.
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11
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Chitnavis JP, Lawson JO. Complete supernumerary leg in association with mesodermal abnormalities - a 16-year follow-up and literature review. Pediatr Surg Int 1996; 11:201-2. [PMID: 24057561 DOI: 10.1007/bf00183770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/1995] [Indexed: 10/26/2022]
Abstract
A male with a complete third leg in association with genito-urinary, anorectal, and colonic defects and an Arnold-Chiari malformation is described at birth and at 16 years of age following surgery. A short review of similar cases over the last century is presented and reference made to reported induction of similar abnormalities in vertebrates.
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12
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Sabry MA, al-Saleh Q, al-Saw'an R, al-Awadi SA, Farag TI. Right upper limb bud triplication and polythelia, left sided hemihypertrophy and congenital hip dislocation, facial dysmorphism, congenital heart disease, and scoliosis: disorganisation-like spectrum or patterning gene defect? J Med Genet 1995; 32:555-6. [PMID: 7562971 PMCID: PMC1050551 DOI: 10.1136/jmg.32.7.555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A Somali female baby with right upper limb triplication, polythelia, left sided hemihypertrophy, congenital hip dislocation, facial dysmorphism, congenital heart disease, and scoliosis is described. It seems that the above described pattern of anomalies has not been reported before. The possible developmental genetic mechanism responsible for this phenotype is briefly discussed.
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Affiliation(s)
- M A Sabry
- Kuwait Medical Genetics Centre, Sulibikhat
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