Clinical Quiz—A Rare Case of Anal Canal Duplication in the Context of Currarino Syndrome

Currarino syndrome (CS) is a rare condition that presents with any combination of a sacral defect, a presacral mass, and an anorectal malformation. This collection, referred to as Currarino's triad, may not necessarily present as all three abnormalities in the diagnosis of the syndrome. Anal canal duplication (ACD) is an even rarer occurrence. We present a case that lies on the CS spectrum with an associated ACD and discuss a complex surgical challenge that necessitated a customized management plan, devised through a multidisciplinary approach.

The Controversy of Surgical Intervention for Anal Canal Duplication in Children

Objective: Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings. Methods: A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications. Results: All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention. Conclusion: Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary. doi: https://doi.org/10.12669/pjms.36.6.1832 How to cite this:Akova F, Altinay S, Aydin E. The Controversy of Surgical Intervention for Anal Canal Duplication in Children. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.1832 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mucosal stripping and muscular layer quilting in the treatment of anal canal duplication: Operative technique

Anal canal duplication (ACD) is the least frequent digestive duplication [1]. It presents as a perineal orifice that ends with a tract along the anal canal [2]. Symptoms are often absent but can occur or worsen with age. Surgical excision of the duplicated anus is required because of the risk of infection and malignancy [3]. Here we present a patient with ACD that was treated with a technique that we pioneered called mucosal stripping and muscular layer quilting (MSMQ). This technique was performed for the first time in our clinic 11 years ago on 2 patients and has been described in a case report [4]. We describe the surgical technique here using a case presentation with photographs that illustrate the technique.