%0 Journal Article
%T Anal Canal Duplication in an 11-Year-Old-Child
%A S. Van Biervliet
%A E. Maris
%A S. Vande Velde
%A D. Vande Putte
%A V. Meerschaut
%A N. Herregods
%A R. De Bruyne
%A M. Van Winckel
%A K. Van Renterghem
%J Case Reports in Gastrointestinal Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/503691
%X Anal canal duplication (ACD) is the least frequent digestive duplication. Symptoms are often absent but tend to increase with age. Recognition is, however, important as almost half of the patients with ACD have concomitant malformations. We present the clinical history of an eleven-year-old girl with ACD followed by a review of symptoms, diagnosis, treatment, and prognosis based on all the reported cases in English literature. 1. Case Report An eleven-year-old foster child was referred to the paediatric gastroenterology department because of an extra perianal orifice. The patient complained of anal pruritus. Previous treatment with mebendazole because of the suspicion of oxyuriasis had no effect. Physical examination revealed an extra orifice, in the midline posterior to the anus. Rectal palpation was normal. The anal canal appeared normal, with normal anal reflexes. This extra orifice had been observed at birth, with an expectative management advised in her native country. Cardiac ultrasound was normal. Magnetic resonance imaging (MRI) revealed a normal sacrum and coccyx but could not demonstrate the extra orifice or fistula. The genitourinary system, as evaluated in MRI, was normal. Fistulography (Figure 1) showed a 1.5£¿cm blind-ending fistula, not communicating with the rectum. Figure 1: Fistulography revealing a blind ending tubular structure. The patient and her parents were counselled about the diagnosis of ACD and the possible complications: inflammation and malignancy. Nevertheless they refused surgical mucosal stripping. 2. Discussion ACD is the least frequent digestive duplication. Clinically, it presents itself as an extra perineal orifice located just behind the anus. Clinically, it is difficult to differentiate ACD from a rectal or anal fistula, however, in noncomplicated ACD inflammation will be absent. Only histology gives diagnostic certainty describing 3 characteristics of ACD: squamous epithelium in the caudal end, transitional epithelium in the cranial end and smooth-muscle cells in the wall of the canal [1, 2]. It is most frequently a tubular (90%) anomaly without communication to the rectum. In 10% of cases, the lesion is cystic [3]. We found only 55 patients (including our patient) with ACD in English literature (Table 1). Females comprise up to 89% of the patients with ACD (Table 1). Table 1: Summary of all reported anal canal duplication cases in English literature. Two hypotheses concerning the origin of anal canal duplication are suggested in literature. Choi and Park postulate it as a consequence of recanalization of a cloacal
%U http://www.hindawi.com/journals/crigm/2013/503691/