Novel approach to a rare communicating anal canal duplication in an 11-month-old female: A case report

Background: Anal canal duplication (ACD) is a rare congenital anorectal malformation (ARM) with limited cases and surgical techniques described in the literature to date. Case summary: A full-term 8-month-old female with a history of constipation was referred to our pediatric surgery clinic for two patent anal orifices draining feculent material. Imaging established that these two openings converged into a common rectum separated by intervening tissue. Intraoperative sphincter mapping further confirmed that the sphincter complex completely encircled the posterior opening and partially surrounded the anterior opening, with viable contractile tissue within the dividing septum. An anoplasty procedure was performed, in which the intervening muscular tissue between the dual anal openings was divided and subcutaneously tunneled to construct a single, functioning neo-anus surrounded by sphincter muscle. There were no postoperative complications, and she continues to have a single, well-functioning anus. Conclusions: Anal canal duplication can be treated successfully with an anoplasty if sufficient sphincter muscle is present. Here, we present a perineal approach for joining two communicating anal openings with excellent results.