Optimizing Surgical Techniques for Anal Canal Duplications in 2 Pediatric Patients

BACKGROUND Anal canal duplications (ACD) are rare in children older than 2 years old. While some patients are asymptomatic, others have a variety of nonspecific symptoms. The definitive treatment is surgical removal, but the best technique varies with each case based on the local situation and the location of the lesion. CASE REPORT We present 2 cases of anal canal duplications in pediatric patients. Despite the atypical presentations of a concomitant cystic, a high suspicion of ACD led to surgical management using different techniques based on its location and local situation. The first patient had a sterile perianal abscess in the ischiorectal fossa, unresponsive to antibiotics and recurrent after surgical drainage. MRI revealed a fistula connecting the cyst to the exterior at the pectineal line, prompting a posterior approach for complete resection of the mass from the rectum. The second patient had an incidentally discovered ischiorectal mass. Imaging suggested a homogeneous cyst adhered to the rectal wall and easily accessible, leading to a successful robotic-assisted surgical resection. Both patients achieved complete anal sphincter function and full recovery postoperatively. Histological analysis in both cases presented typical characteristics found in ACD. CONCLUSIONS Although ACD is rare in pediatric patients over 2 years of age, cystic or infected lesions in the ischiorectal fossa should be considered as differential diagnoses. Radiological imaging is crucial for understanding the cyst's location and determining the optimal surgical approach. As presented in our cases, an open posterior approach may be considered when the lesion is or has been complicated by previous infection, associated with a fistula, as opposed to non-complicated cases in which a mini-invasive approach may be ideal.