Anterior rectal duplication: A diagnostic challenge

Anterior Anorectocolonic Tubular Duplication Presenting as Rectovestibular Fistula in an Infant

“…The symptoms reported for anterior anorectal duplications are similar to those for posterior anorectal duplications, including recurrent gastroenteritis and failure to thrive, isolated rectal bleeding, chronic constipation with soiling, and rectal prolapse [7]. Due to the differing presentations for anterior anorectal duplications, various diseases must be considered part of the differential diagnosis, including sacrococcygeal teratoma, anal fistula due to Crohn's disease, rectal prolapse, dermoid cysts, hydrocolpos, chordoma, leiomyosarcoma, and hydrometrocolpos [3,4,7]. Because it is challenging to distinguish anterior anorectal duplications from other diseases, delayed diagnosis can occur [4].…”

“…Based on their embryogenesis, anorectal duplications would be expected to be located posterior to the rectum. In fact, most anorectal duplications are located posterior to the anus; anterior rectal duplications are very rare, with fewer than 10 cases reported [7].…”

“…Various diagnostic modalities can assist in diagnosis, such as abdominal ultrasonography, contrast studies, computed tomography, and MRI [7]. In particular, MRI can provide multiplanar views, allowing identification of pelvic structures and ruling out other diagnoses [6,7].…”

“…In particular, MRI can provide multiplanar views, allowing identification of pelvic structures and ruling out other diagnoses [6,7]. To evaluate communication between duplications and normal bowels, contrast studies can be helpful in accurately delineating the anatomy of the duplicated rectum [6].…”

“…Malignant changes in anorectal duplications have also been reported in adult patients, although not in pediatric populations [1,10]. When there was no evidence of fistula formation between the duplication cyst and vagina, cyst unroofing and residual mucosa ablation was applied [7]. In the other case of anterior rectal duplication without rectovaginal fistula, septum division via surgical staplers was performed [3].…”