Congenital Total Colonic Duplication with Double Anus-Recognized Late in a Child

Abstract

Background: Double ani with colonic duplication is rarely seen in children. There are no standard management strategies. Clinical Description: A 6-year-old girl presented with fecal discharge from an abnormal site in the perineum in addition to defecation through the normal anal opening. Although present since birth, parents did not seek medical/surgical care till school age. Perineal examination revealed normal labia majora, minora, and clitoris, normally placed urethral opening, septate vagina, and vestibular fistula with a normal anus. Digital rectal examination could not appreciate any abnormal communication. Management and Outcome: Initially, a diversion stoma was planned. At surgery, a duplicated colon was identified, dye study confirming duplication of hindgut without any communication distally. During definitive surgery, the vestibular fistula (abnormal bowel opening in the vestibule) was mobilized and the common wall of duplicated rectum was divided the end of the vestibular colon was closed, and the perineal body was reconstructed. At the time of stoma reversal, after 3 months, proximal communication between duplicated colons found up to ileocecal region. Both proximal and distal limb common walls were divided with stapler, and bowel continuity was restored. The child remained well and continent till a follow-up of 2 years. Conclusion: Our case highlights the importance of a thorough perineal examination including all orifices at birth or during routine health checkup visits. A second anal orifice may remain unrecognized till later childhood, as defecation predominantly occurs through the true anus, the duplicate anal orifice being minimally functional or nonfunctional.