Early Diagnosis of Anal Canal Duplication: The Importance of a Physical Examination

Abstract

Anal canal duplication (ACD) is an extremely rare congenital anomaly of the intestinal tract that presents as an extra opening of the anal canal without communication with the anorectum. We present the case of a five-year-old male presenting to the pediatrician without symptoms and upon physical examination, a duplicated anal canal along the midline was discovered. The patient was admitted for surgery and the canal was removed via mucosal stripping. Postoperatively, the patient recovered well. The present study aims to expand on our knowledge of a very rare pathological entity and emphasize the importance of a complete pediatric physical examination.

Anal Canal Duplication in a 25-Year-Old Female Patient

“…ACD occurs more commonly in females, with a predilection of nine females for every male [1,4,6]. Clinically, it can be diagnosed early in life through a complete physical examination where an accessory orifice of approximately 2-5 mm in diameter is seen above the native anal orifice at the 6 o'clock radius [1,4,8,12], as is the lesion found in our patient.…”

“…ACD is a congenital malformation that typically manifests early in life [4,5], but in a minority of cases such as the current case, it manifests in adulthood [1]. In a compilation of case series and case reports with a total of 72 patients, the maximum age was 14 years [6], much younger than the case we present.…”

“…Anal canal duplication (ACD) is a congenital malformation located in the midline above the native anal orifice [1,2]. It was first described in 1956 by Dukes et al [1]; subsequently, Ochiai et al defined it as a lesion that should include "a squamous epithelium at the caudal end, a transitional epithelium at the cranial end, and smooth muscle cells in the wall of the duplicated anal canal" [3]. ACD presents and is usually diagnosed early in life [4,5].…”

“…Thirty-six percent of cases may be associated with other malformations [4] such as myelomeningocele, midline defects [6,7], or most commonly, urinary malformations in up to 45% of cases [8]. It is even part of some rare syndromes such as Currarino syndrome, which include a characteristic triad associating anal stenosis, sacrococcygeal malformation, and presacral mass [1]. ACD is one of the rarest duplications of the gastrointestinal tract [9].…”