Clinical Snapshot
Anal Canal Duplication
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A 2-year-old female patient was seen in the pediatric surgical outpatient clinic after her parents noticed a “fistula opening” next to the anus while changing her diaper (Figure). The child was asymptomatic, and no infections or secretion had occurred. Based on the suspicion of anal canal duplication (ACD), resection was performed using a minimally invasive posterior sagittal approach. Magnetic resonance imaging ruled out a presacral mass. Although duplications can occur anywhere along the gastrointestinal tract, anal canal duplication is an extremely rare congenital malformation, with around 100 published cases, and is often misinterpreted as an anal fistula. It presents as an additional anal canal opening in the midline (6 o’clock lithotomy position) without communication to the anorectum and often initially remains asymptomatic. Symptoms may be delayed, meaning that some cases are not diagnosed until adulthood. Diagnosis is based on a differentiated clinical examination, with histopathology confirming the suspicion. It is important to rule out associated malformations. Complete excision should be performed at a specialized pediatric surgical center with expertise in colorectal surgery.
Dr. med. Sabine Drossard, Danilo Skudelny, Prof. Dr. med. Thomas Meyer, Abteilung für Kinder- und Jugendchirurgie – Kinderurologie und Kindertraumatologie, Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie; Universitätsklinikum Würzburg, Meyer_T@ukw.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Drossard S, Skudelny D, Meyer T: Anal canal duplication. Dtsch Arztebl Int 2025; 122: 474a. DOI: 10.3238/arztebl.m2025.0095
