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CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e102-e106
DOI: 10.1055/s-0042-1750028
Case Report

Complete Colonic Duplication and Perineal Fistula: Transanal Mucosectomy of the Ectopic Rectum

Authors

  • Johannes W. Duess 

    1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

  • Peter Zimmermann

    1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

  • Franz W. Hirsch

    2   Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany

  • Daniel Graefe

    2   Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany

  • Martin Lacher

    1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

  • Jan-Hendrik Gosemann

    1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Abstract

Background Colonic duplication may present in different anatomic variants. The surgical approach towards these anomalies can be challenging and has implications for subsequent future continence.

Case Description We report on a 1-year-old girl with congenital heart defect and pacemaker who was referred to us with an anorectal malformation. The patient was stooling from both an anus and a perineal fistula. Examination under anesthesia revealed an orthotopic and age-appropriate sized anus with surrounding sphincter and a second rectal lumen ending as a perineal fistula. A computed tomography and contrast enema indicated colonic duplication. Exploratory laparotomy showed a duplicated terminal ileum leading to two ceca and appendices, which joined to a duplicated colon with a septum and common mesentery. At the rectosigmoid junction, one part of the duplication ended as a perineal fistula, the second one led to the (orthotope) anus. The common colonic wall was divided using a stapler. The rectal duplication leading to the perineal fistula was not completely resected but treated by mucosectomy only (Soave plane) leaving its muscular cuff in place. Finally, an ileostomy was created. The postoperative course was uneventful. A contrast enema prior to ostomy takedown demonstrated a well-configurated colon and rectum without stenosis or impaction. The girl is currently continent with a complete resolution of her constipation.

Conclusion In cases of complete colonic duplication division of the common wall is simple and safe. Mucosectomy of the ectopic rectum limits pelvic dissection and preserves the entire muscular wall of the duplicated orthotope rectum.

Keywords

colonic duplication - mucosectomy - continence


Publication History

Received: 06 August 2021

Accepted: 11 March 2022

Article published online:
16 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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