Surgery 2, Department X, Researching Future Chirurgie 2, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania.
Watford Cancer Centre, Gynecological Oncology Department, West Hertfordshire NHS Hospitals Trust, Watford WD18 0GU, UK.
Medicina (Kaunas). 2021 Nov 4;57(11):1205. doi: 10.3390/medicina57111205.
Anal canal duplication (ACD) is a very rare condition, diagnosed and treated mostly in childhood. Less than 90 cases have been reported in the literature so far. We are presenting a case of a young woman who underwent surgical excision of the duplication when she was 27 years old. The patient was unaware of her condition and was referred from a gynaecological office to the surgical department with a history of perianal discomfort and mucus discharge. Local examination showed an external orifice posterior to the anal opening, on the median line, which had the macroscopic appearance of a secondary anal orifice. The opening was about 0.5 cm in diameter. Exploration of the tract revealed a length of about 4 cm. MRI described the aforementioned tract, parallel to the anal canal, with no other anomalies mentioned. Under spinal anesthesia, with the patient in jackknife position, the accessory anal canal was surgically excised. The pathology report showed the presence of smooth muscle fibers and typical anal glands in the specimen. After a five-year follow-up, the patient showed no recurrence or any other related local symptoms. Absence of perianal abscess from the patient history, along with the macroscopic aspect of the opening similar to a secondary anal orifice on the midline, should raise the suspicion of ACD. Due to the lack of bothersome symptomatology, the patient did not seek any special investigations for her condition until she was in her late twenties. ACD is a very rare condition in adults that might pass unnoticed, but a midline opening posterior to the anus should always raise the suspicion of a secondary anal canal. Surgery is the only cure for this condition with good results after a proper pre-operative workout to reveal others simultaneous malformations.
肛管直肠重复畸形（ACD）是一种非常罕见的疾病，主要在儿童期诊断和治疗。迄今为止，文献中报道的病例不到 90 例。我们报告了一例 27 岁年轻女性的病例，她因直肠重复畸形接受了手术切除。患者对自己的病情并不知情，因肛周不适和黏液分泌而从妇科转至外科就诊。局部检查显示肛门后正中线上有一个外口，外观上类似于第二个肛门。开口直径约 0.5 厘米。探查发现管道长约 4 厘米。MRI 描述了上述管道，与肛管平行，未提及其他异常。在脊髓麻醉下，患者取折刀位，经肛门切除副肛管。病理报告显示标本中存在平滑肌纤维和典型的肛腺。经过五年的随访，患者未出现复发或任何其他相关局部症状。患者无肛周脓肿病史，开口位于肛门后正中线上，外观类似于第二个肛门，应高度怀疑 ACD。由于患者没有明显的症状，直到二十多岁才寻求特殊检查。成人 ACD 非常罕见，可能未被发现，但肛门后正中线上的中线开口应始终怀疑存在第二个肛管。对于这种情况，手术是唯一的治疗方法，如果术前进行适当的准备以揭示其他同时存在的畸形，手术效果良好。
