Anal canal duplication in infants and children - A series of 6 cases

The authors present a series of six anal canal duplications (ACD), duplicat ions of the alimentary tract located along the posterior side of the anal c anal, with a perineal opening just behind the anus. Five asymptomatic dupli cations were diagnosed before the age of one year, by simple perineal Inspe ction. A twelve-year-old girl presented with perineal and anal pains and di arrhoea. Fistulography revealed a tubular structure in five cases and a cys tic structure in one case, behind the normal anal canal, in one case commun icating with it presacral sacrococcygeal teratoma was found in two children and in one case it was visualised by preoperative US in an infant with a l umbosacral myelomeningocele. Surgical excision was performed by a perineal approach in 5 cases, by a combined sacral and perineal approach in the last case, because of the associated teratoma. Non-invasive preoperative invest igations, consisting of a pelvic X-ray, US examination, barium enema and fi stulography, are sufficient in most cases; MRI is reserved for special indi cations. Surgical treatment restores a normal perineal aspect, without sequ elae, and avoids complications like those described in other types of diges tive duplications: infection, ulceration, bleeding, malignant changes durin g later adult life. Associated anomalies are frequently described in the li terature, especially presacral tumours (16%) and anorectal malformations (2 1%); they can influence the management, the surgical approach and the funct ional prognosis.