Rectal duplication in an adult cat: a novel transanal surgical approach

Abstract

Case summary A 3-year and 8-month-old male entire European domestic shorthair cat was presented with a history of recurrent rectal prolapse, straining and pain when defaecating. Previous non-surgical and surgical treatments had not provided a satisfactory result. Rectal prolapse had recurred within 2 weeks of treatment. Upon clinical examination, an intraluminal mass could be palpated rectally. A CT scan examination revealed the mass was of a cystic nature and the cyst was surgically excised via a transanal approach. On histological evaluation, the cyst walls consisted of three of the layers of normal rectum: mucosa, muscularis of the mucosa and submucosa. These findings led to the definite diagnosis of rectal duplication. Relevance and novel information Enteric duplication is among the differential diagnoses for straining and rectal prolapse in cats. This condition has previously been discussed in the veterinary literature, with a single case report describing a rectal duplication in a cat. In that particular case, the authors described a perineal surgical approach. Here we present a novel approach whereby the duplicated material was excised transanally in order to limit intra- and postoperative morbidity. The clinical outcome was excellent in our case, with complete resolution of clinical signs and no recurrence 18 months after surgery.

What Do We Know About Alimentary Tract Duplications in Cats?

“…Most studies have described duplications in cats as cystic with an independent lumen (93%, n= 13/14) (Radlinsky et al, 2005;Kershaw et al, 2008;Parry-Smith et al, 2008;Kook et al, 2010;Bernardé et al, 2014;Doran et al, 2015;Hobbs et al, 2015;Agut et al, 2017;Kramer et al, 2017;Turner et al, 2019;Carbonell Buj et al, 2020), similarly to our case cyst's features. In humans most duplications are cystic with no lumen communication, whereas some are cylindrical structures that can or not have direct intestinal communication (Bhatt et al, 2020 Multiple level enteric duplications are rather uncommon but have been reported to occur in humans, with oesophageal duplication associated with small bowel duplication being the most frequent combination (Hur et al, 2007).…”

“…In our case, the cyst fulfilled the three anatomic criteria defined by Gross and colleagues (1952) to be considered a duplication since it was (1) associated with the alimentary tract, (2) had a smooth muscle layer and (3) had gastrointestinal-like epithelium according to histopathology analysis. Only twelve other reports have been found in literature describing similar alimentary tract duplications in cats (Radlinsky et al, 2005;Kershaw et al, 2008;Parry-Smith et al, 2008;Kook et al, 2010;Bernardé et al, 2014;Doran et al, 2015;Hobbs et al, 2015;Agut et al, 2017;Kramer et al, 2017;Turner et al, 2019;Carbonell Buj et al, 2020;Fruehwald and Ellison 2020).…”

“…Symptoms observed in previous reports were related to the duplication's anatomic site. Oesophagus cysts coursed with dyspnea (Bernardé et al, 2014) and regurgitation (Doran et al, 2015); small intestine cysts led mainly to recurrent vomiting (Kershaw et al, 2008;Parry-Smith et al, 2008;Bernardé et al, 2014;Hobbs et al, 2015;Agut et al, 2017), even though one case was an asymptomatic cat (Radlinsky et al, 2005); and large intestine duplications caused, mostly, constipation and straining to defecate (Kramer et al, 2007;Kook et al, 2010;Turner et al, 2019;Carbonell Buj et al, 2020;Fruehwald and Ellison 2020). In the present case, the cat presented recurrent emesis and mild epigastric pain but no other symptoms.…”

“…A scoping review was performed using data collected from the PubMed ® database and the current case description. Articles included considered histologically confirmed alimentary tract duplications (Radlinsky et al, 2005;Kramer et al, 2007;Kershaw et al, 2008;Parry-Smith et al, 2008;Kook et al, 2010;Bernardé et al, 2014;Doran et al, 2015;Hobbs et al, 2015;Agut et al, 2017;Turner et al, 2019;Carbonell Buj et al, 2020;Fruehwald and Ellison, 2020).…”

“…Clinical signs are usually non-specific, and cats can even be asymptomatic (Radlinsky et al, 2005). Vomiting, anorexia, digestive obstruction, rectal prolapse and respiratory signs (due to oesophageal cyst) have been reported (Kershaw et al, 2008;Parry-Smith et al, 2008;Kook et al, 2010;Bernardé et al, 2014;Hobbs et al, 2015;Agut et al, 2017;Kramer et al, 2017;Carbonell Buj et al, 2020). Image diagnostic techniques are required to characterize lesion morphology with emphasis on ultrasound examination -US (Nebot et al, 2018) and histological evaluation is essential to avoid misdiagnosis (Hwang et al, 2017).…”