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Ailhaud A, Alao O, Sole Cruz E, Faguet R, Verot PL, Piolat C, Jacquier C, Rabattu PY. Anal canal duplication in children: a monocentric experience of 12 cases. Pediatr Surg Int 2021; 37:1007-1012. [PMID: 33900436 DOI: 10.1007/s00383-021-04910-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Anal canal duplication is a rare malformation characterized by a second perineal opening positioned behind the anus, which is generally observed at 6 o'clock in the lithotomy position. The purpose was to describe six new cases of anal canal duplication (in addition to our previously reported series of six patients) with the aim of providing further clinical information about this anomaly. METHODS We described 6 new cases of anal canal duplication in terms of symptoms, anatomical disposition, imaging results, and histopathology. Clinical details of these cases and those already reported (n = 12) were summarized and compared to existing literature. RESULTS A total of 12 cases were reported over 34 years. 17% of the patients were male, constituting the only subgroup to present a communication with the digestive tract. A single patient, diagnosed at 12 years, was symptomatic. Half of the patients had at least one associated malformation. All patients underwent surgery, either with a posterior sagittal or perineal approach. CONCLUSION Diagnosis of anal canal duplication should be suspected when a perineal opening positioned behind the anus is present, and necessitates further exploration by a comprehensive clinical examination and imaging. Surgery is always required, typically performed via a posterior sagittal approach. The postoperative course is usually uncomplicated.
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Affiliation(s)
- Antoine Ailhaud
- Department of Digestive Surgery, University Hospital of Grenoble, Grenoble, France
| | - Oyekashopefoluw Alao
- Department of Digestive Surgery, University Hospital of Grenoble, Grenoble, France
| | - Eva Sole Cruz
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, Grenoble, France.,2ID17 Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, France
| | - Romain Faguet
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Pierre-Louis Verot
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Christian Piolat
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Catherine Jacquier
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Pierre-Yves Rabattu
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, Grenoble, France. .,Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France.
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Abstract
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.
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Affiliation(s)
- Fatih Akova
- Dr. Fatih Akova, MD. Assistant Professor, Pediatric Surgery Department, Biruni University, Istanbul, Turkey. Pediatric Surgery Department, University of Health Science, Faculty of Medicine, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Serdar Altinay
- Dr. Serdar Altinay, MD. Associate Professor, Pathology Department, University of Health Science Bakırköy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Emrah Aydin
- Dr. Emrah Aydin, MD. Assistant Professor, Pediatric Surgery Department, Koc University School of Medicine, Istanbul, Turkey
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Palazon P, Julia V, Saura L, de Haro I, Bejarano M, Rovira C, Tarrado X. Anal canal duplication and triplication: a rare entity with different presentations. Pediatr Surg Int 2017; 33:609-617. [PMID: 28255623 DOI: 10.1007/s00383-017-4074-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- P Palazon
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
| | - V Julia
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - L Saura
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - I de Haro
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - M Bejarano
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - C Rovira
- Department of Pathology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - X Tarrado
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Arakawa T, Hwang SE, Kim JH, Wilting J, Rodríguez-Vázquez JF, Murakami G, Hwang HP, Cho BH. Fetal growth of the anal sinus and sphincters, especially in relation to anal anomalies. Int J Colorectal Dis 2016; 31:493-502. [PMID: 26615552 DOI: 10.1007/s00384-015-2455-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
| | - Si Eun Hwang
- Department of Surgery, Daejeon Sun Hospital, Daejeon, Republic of Korea
| | - Ji Hyun Kim
- Department of Anatomy, Chonbuk National University Medical School, Geonji-ro 20, Deokjin-gu, Jeonju, 561-712, Republic of Korea.
| | - Joerg Wilting
- Department of Anatomy, School of Medicine, Georg-August-Universität Gőtingen, Gőttingen, Germany
| | - José Francisco Rodríguez-Vázquez
- Department of Anatomy and Human Embryology, Institute of Embryology, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
| | - Hong Pil Hwang
- Department of Surgery & Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Baik Hwan Cho
- Department of Surgery & Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
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Mirzaei R, Mahjubi B, Alvandipoor M, Karami MY. Late presentation of anal canal duplication in adults: a series of four rare cases. Ann Coloproctol 2015; 31:34-6. [PMID: 25745625 PMCID: PMC4349915 DOI: 10.3393/ac.2015.31.1.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/19/2014] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Rezvan Mirzaei
- Department of Surgery, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Teheran, Iran
| | - Bahar Mahjubi
- Department of Surgery, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Teheran, Iran
| | - Mina Alvandipoor
- Department of Surgery, Mazandaran University of Medical Sciences, Sari, Iran
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