Anal Canal Duplication Associated with Presacral Cyst in an Adult

Abstract

Abstract:Anal canal duplication (ACD) is a rare congenital malformation, usually detected early in life. We report a case of a 67-year-old female with symptomatic ACD associated with a presacral cyst. Physical examination revealed an accessory opening located in the midline, posterior to the true anus. Imaging examinations, including fistulography, endoanal ultrasonography, and magnetic resonance imaging, revealed a blindending fistulous tract without connecting with the rectum and a presacral cyst posterior to the rectum. Complete surgical excision of the tract with cyst was performed through a posterior sagittal approach. Histologic examination revealed squamous epithelium lining and smooth muscle bundles, thereby confirming ACD. The postoperative course was uneventful, and the patient was doing well; no recurrence was observed 4 years after surgery. ACD can present for the first time in infants, children, and adults. Imaging examinations are useful for the diagnosis and preoperative assessment of ACD. Therefore, ACD should be considered in the differential diagnosis, even in adults, when a posterior perineal orifice is encountered, particularly in female patients. Once ACD is suspected, intense imaging inspection is recommended to visualize the ACD and associated anomalies, and surgical removal is warranted to prevent inflammatory complications or malignant changes.

Anal Canal Duplication in an Adult Female—Case Report and Pathology Guiding

“…asymptomatic when diagnosed, one third are mildly symptomatic, and one in fifth present with complications [5]. Thus, we present a case of a young woman diagnosed with ACD in her late twenties.…”

“…ACD is 9:1 more common in women than in men and associates other malformations up 36% of the cases [3,4]. Half of the patients are asymptomatic when diagnosed, one third are mildly symptomatic, and one in fifth present with complications [5]. Thus, we present a case of a young woman diagnosed with ACD in her late twenties.…”

Cystic lesions of the retrorectal space

“…Only occasionally do cases go undiagnosed into adult life 41 . Some cases are initially misdiagnosed as fistula‐in‐ano 42 . Rare cases may grow sufficiently large as to extend into the retrorectal space 42,43 .…”

“…First, recanalisation in later embryonic life of a remnant of the cloacal membrane, 44 and secondly, duplication of the dorsal aspect of the cloaca in early embryonic life 45 . Other congenital malformations are seen in approximately one‐third of patients 42 …”

“…They are lined mainly by non‐keratinising squamous epithelium. Transitional and sometimes columnar epithelia are present towards the cranial aspect of the duplication 41,42 . Watery to mucoid contents are found in the lumen.…”