The duplication of the rectum: presentation and therapy

Abstract

Aim: to delineate the symptomatic features and to emphasize the necessity of early diagnosis and complete surgical excision of rectal duplications. Method. We undertook a retrospective and contemporary review of all patients. Clinical recordings, preoperative evaluations, intraoperative and histological findings, and current patients’ condition were studied. Results. Age of the six patients ranged from new-born to 13 years. There was a broad spectrum of clinical presentation: two children were seen after previous therapy elsewhere with a mistaken diagnosis of perianal fistula, respectively undefined abdominal pain; two presented with exstrophic duplication of the rectum; one neonate was seen with an anal cleft and one infant with rectal bleeding and retrorectal palpable tumour. Paraclinical investigations established preoperative diagnosis in one patient, aided it in two others, and detected associated anomalies in two further patients. All duplications were “in toto“ removed using laparotomy (n = 1), transanal (n = 1), or perineal sagittal approach(n = 4). All duplications had contact with the rectum. Smooth muscle coat and intestinal epithelial layer were histological demonstrated in each case. Conclusions. Rectal duplications are rare anomalies. Clinical manifestations may include abdominal pain, obstipation, rectal bleeding, urinary or bowel obstruction, rectal polyp, perianal fistula, perineal abscess, and pelvic, abdominal, retroperitoneal or perineal mass. Early diagnosis avoids prolonged symptomatic treatment and unnecessary operative procedures. Complete excision is curative.