Total colonic duplication with vestibular fistula, including one with colorectal triplication: A case series

Complete colonic duplication associated with rectovestibular communication is extremely uncommon, whereas colorectal triplication has been documented only in isolated case reports. Case 1 involved a 34-day-old term baby girl, who presented with passage of stool through both a normal anus and an accessory vestibular orifice. Dual-tract contrast studies and hydrocolonic MRI demonstrated complete colonic duplication converging at a single cecum into which the terminal ileum inserted. At a postnatal age of 3 months, a combined Pfannenstiel and perineal approach allowed resection of the duplicated rectum and creation of a termino-lateral sigmoid–sigmoid unification. Postoperative recovery was uneventful, and age-appropriate continence was confirmed during follow-up. Case 2 concerned a female neonate delivered at 41 weeks’ gestation who began passing meconium on day two of life through both the anus and a vestibular orifice. Contrast opacification demonstrated complete colonic duplication, with the anterior duplicated segment coursing toward the vagina. At five months, combined perineal dissection and Pfannenstiel exposure revealed total colonic duplication extending to the terminal ileum, associated with duplication of both ceca and appendices. The duplicated rectum was mobilized, inverted, and excised. Intra-operatively, a rectal triplication embedded within the shared rectal wall was also identified and resected. All three rectosigmoid segments were subsequently anastomosed to the orthotopic colon using stapled unification, and the perineal body was reconstructed. Postoperative recovery was favorable with normal bowel function. In females with a patent anus who pass stool through an accessory vestibular orifice, underlying colonic duplication should be systematically ruled out.