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Dominguez-Muñoz A, Fernandez-Portilla E, Davila-Perez R, Lizarraga-Rodriguez I, Leyva-Castellanos MDL, Nieto-Zermeño J. Colorectal duplication with rectovestibular fistula treated through an anterior transanorectal approach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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2
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Piplani R, Acharya SK, Bagga D. Recto-vestibular fistula with colonic duplication: report of three cases and review of literature. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00186-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Anorectal malformations associated with colonic duplications are a rare condition. Double terminations of tubular colonic duplication in the perineum are even rarer. Colonic duplication may have different presentations according to its location and size and incidence of less than 15% of all gastrointestinal duplications. We hereby report three such cases of recto-vestibular fistula along with underlying tubular colorectal duplication over a period of 10 years (2010–2020) managed successfully by different surgical approaches. These cases also illustrate the diagnostic challenge and variable presentation of colonic duplications in female patients with recto-vestibular fistula.
Case presentation
Case 1 is a patient with flank heteropagus with absent anal opening and recto-vestibular fistula, while cases 2 and 3 presented as suspected H-type recto-vestibular fistula with normal anal opening. All the cases were however managed with a specific surgical approach on case basis. Duplicated colon was excised in case 1, but in case 2 and case 3, duplicated colon was converted into single channel using proximal and distal staplers. Further definitive repair of female recto-vestibular fistula was done.
Conclusions
Colorectal duplication is a rare congenital malformation, and their association with anorectal malformations is even rarer. This association can have varied presentation, and surgical approach should be according to the congenital anatomical variations on case-to-case basis. Colonic duplications should always be ruled out in a female newborn child with history of passage of stools both from the vestibule and anus.
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Successful full-length sealing and division of the common wall in a 2-year-old boy with complete tubular colorectal duplication. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jester I, Parveen R. Complete tubular colonic duplication ending in a common channel as a recto vestibular fistula: A case report and literature review of management options. J Indian Assoc Pediatr Surg 2022; 27:103-105. [PMID: 35261524 PMCID: PMC8853591 DOI: 10.4103/jiaps.jiaps_275_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/06/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022] Open
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Duess JW, Zimmermann P, Hirsch FW, Graefe D, Lacher M, Gosemann JH. Complete Colonic Duplication and Perineal Fistula: Transanal Mucosectomy of the Ectopic Rectum. European J Pediatr Surg Rep 2022; 10:e102-e106. [PMID: 35992310 PMCID: PMC9381363 DOI: 10.1055/s-0042-1750028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/11/2022] [Indexed: 02/07/2023] Open
Abstract
Background
Colonic duplication may present in different anatomic variants. The surgical approach towards these anomalies can be challenging and has implications for subsequent future continence.
Case Description
We report on a 1-year-old girl with congenital heart defect and pacemaker who was referred to us with an anorectal malformation. The patient was stooling from both an anus and a perineal fistula. Examination under anesthesia revealed an orthotopic and age-appropriate sized anus with surrounding sphincter and a second rectal lumen ending as a perineal fistula. A computed tomography and contrast enema indicated colonic duplication. Exploratory laparotomy showed a duplicated terminal ileum leading to two ceca and appendices, which joined to a duplicated colon with a septum and common mesentery. At the rectosigmoid junction, one part of the duplication ended as a perineal fistula, the second one led to the (orthotope) anus. The common colonic wall was divided using a stapler. The rectal duplication leading to the perineal fistula was not completely resected but treated by mucosectomy only (Soave plane) leaving its muscular cuff in place. Finally, an ileostomy was created. The postoperative course was uneventful. A contrast enema prior to ostomy takedown demonstrated a well-configurated colon and rectum without stenosis or impaction. The girl is currently continent with a complete resolution of her constipation.
Conclusion
In cases of complete colonic duplication division of the common wall is simple and safe. Mucosectomy of the ectopic rectum limits pelvic dissection and preserves the entire muscular wall of the duplicated orthotope rectum.
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Affiliation(s)
- Johannes W. Duess
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Peter Zimmermann
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Franz W. Hirsch
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Daniel Graefe
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Destro F, La Pergola E, Maestri L, Meroni M, Vella C, Riccipetitoni G. Total colonic tubular duplication causing severe constipation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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7
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Abstract
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
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Samuk I, Levitt M, Dlugy E, Kravarusic D, Ben-Meir D, Rajz G, Konen O, Freud E. Caudal Duplication Syndrome: the Vital Role of a Multidisciplinary Approach and Staged Correction. European J Pediatr Surg Rep 2015; 4:1-5. [PMID: 28018799 PMCID: PMC5177553 DOI: 10.1055/s-0035-1570370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/09/2015] [Indexed: 11/08/2022] Open
Abstract
Caudal duplication syndrome is a rare entity that describes the association between congenital anomalies involving caudal structures and may have a wide spectrum of clinical manifestations. A full-term male presented with combination of anomalies including anorectal malformation, duplication of the colon and lower urinary tract, split of the lower spine, and lipomyelomeningocele with tethering of the cord. We report this exceptional case of caudal duplication syndrome with special emphasis on surgical strategy and approach combining all disciplines involved. The purpose of this report is to present the pathology, assessment, and management strategy of this complex case.
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Affiliation(s)
- Inbal Samuk
- Department of Pediatric Surgery, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - Marc Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Elena Dlugy
- Department of Pediatric Surgery, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - Dragan Kravarusic
- Department of Pediatric Surgery, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - David Ben-Meir
- Pediatric Urology Unit, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - Gustavo Rajz
- Pediatric Neurosurgery Unit, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - Osnat Konen
- Radiology Department, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
| | - Enrique Freud
- Department of Pediatric Surgery, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Petach Tikvah, Israel
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Karkera PJ, Bendre P, D'souza F, Ramchandra M, Nage A, Palse N. Tubular Colonic Duplication Presenting as Rectovestibular Fistula. Pediatr Gastroenterol Hepatol Nutr 2015; 18:197-201. [PMID: 26473141 PMCID: PMC4600705 DOI: 10.5223/pghn.2015.18.3.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 12/24/2022] Open
Abstract
Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in about 15% of all gastrointestinal duplications. Double termination of tubular colonic duplication in the perineum is even more uncommon. We present a case of a Y-shaped tubular colonic duplication which presented with a rectovestibular fistula and a normal anus. Radiological evaluation and initial exploration for sigmoidostomy revealed duplicated colons with a common vascular supply. Endorectal mucosal resection of theduplicated distal segment till the colostomy site with division of the septum of the proximal segment and colostomy closure proved curative without compromise of the continence mechanism. Tubular colonic duplication should always be ruled out when a diagnosis of perineal canal is considered in cases of vestibular fistula alongwith a normal anus.
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Affiliation(s)
- Parag J Karkera
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Pradnya Bendre
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Flavia D'souza
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Mukunda Ramchandra
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Amol Nage
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Nitin Palse
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
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Balaji DK, Basavaraju M. Incidentally found rectal duplication during surgery for rectovestibular fistula and its management. J Indian Assoc Pediatr Surg 2015; 20:48-50. [PMID: 25552834 PMCID: PMC4268759 DOI: 10.4103/0971-9261.145556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Association of rectal duplication with rectovestibular fistula is rare. A 3-month-old patient underwent primary posterior sagittal anorectoplasty (PSARP) for rectovestibular fistula. During surgery the patient was found to have a rectal duplication (RD). We managed the case by excising the common wall and fenestrating the two lumens together and completed the PSARP.
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Affiliation(s)
- Dhiraj K. Balaji
- Department of Pediatric Surgery, Vydehi Institute of Medical Science and Research Centre, Whitefield, Bangalore, Karnataka, India
| | - Mamatha Basavaraju
- Department of Pediatric Surgery, Vydehi Institute of Medical Science and Research Centre, Whitefield, Bangalore, Karnataka, India
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Castejón-Casado J, Muñoz Miguelsanz M, Diaz EM, Gomez MG, Garcia MP, Valade RF. Acute abdomen secondary to complete tubular colonic duplication. J Indian Assoc Pediatr Surg 2014; 19:166-8. [PMID: 25197196 PMCID: PMC4155635 DOI: 10.4103/0971-9261.136477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 6-month-old infant who presented with a complete duplication of the large intestine, debuting clinically with acute abdomen and severe metabolic disorders. We discuss the pathogenesis and morphology of the lesions, diagnostic difficulties and peculiarities of surgical treatment.
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Affiliation(s)
| | - Ma Muñoz Miguelsanz
- Division of Pediatric Surgery, Hospital "Virgen de las Nieves", Granada, Spain
| | - E Moreno Diaz
- Division of Pediatric Surgery, Hospital "Virgen de las Nieves", Granada, Spain
| | - M Garcia Gomez
- Division of Pediatric Surgery, Hospital "Virgen de las Nieves", Granada, Spain
| | - Ma Padilla Garcia
- Division of Pediatric Surgery, Hospital "Virgen de las Nieves", Granada, Spain
| | - R Fernandez Valade
- Division of Pediatric Surgery, Hospital "Virgen de las Nieves", Granada, Spain
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12
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Colonic duplication with recto-urethral fistula: Elusive diagnosis and successful treatment in a resource-limited setting. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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