Yan Jun,Chen Yajun,Peng Chunhui,et al.Clinical characteristics and surgical management of total colorectal duplication in children[J].Journal of Clinical Pediatric Surgery,,():734-740.[doi:10.3760/cma.j.cn101785-202503001-006]
Clinical characteristics and surgical management of total colorectal duplication in children
- Keywords:
- Duplication Anomaly; Colon and Rectum; Anus; Surgical; Child
- Abstract:
- Objective To explore the clinical characteristics,diagnostic approaches,and surgical treatment strategies for total colorectal duplication in children. Methods A retrospective analysis was conducted on pediatric patients with total colorectal duplication who were surgically treated at Beijing Children‘s Hospital,Capital Medical University,from January 2010 to December 2024.Additionally,relevant literature published between 2000 and 2024 was reviewed using the PubMed,Wanfang Medical Network,and CNKI databases.Clinical presentations,diagnostic methods,and surgical management strategies were summarized and analyzed. Results Among five children diagnosed with total colorectal duplication,there were three females and two males.The median age at surgery was 1.1 years (range:0.6-11.6 years).All patients exhibited defecation through a normally located anus within the first month of life,with additional vestibular fecal leakage in females or fecal debris in urine in males.3 children presented with a hemispherical protrusion of anorectal mucosa during straining.Diagnosis was established preoperatively through perineal physical examination,ultrasound,and contrast studies of the rectum and fistula.The surgical strategy included fecal diversion of the duplicated colon,closure of the duplicated rectal fistula,and preservation of the anayomically correct rectum and anus.After a median follow-up of 8.2 years (range:0.3-14.5 years),all patients had resolution of symptoms and satisfactory bowel function.A total of 23 eligible articles were identified,reporting 27 pediatric cases of total colorectal duplication (15 females and 12 males).Among them,11 girls had normal anal defecation with associated vestibular or perineal fecal leakage,and 5 boys presented with fecal contamination in urine or anorectal bulging; others showed varying symptoms.Diagnosis was achieved in 15 cases primarily through contrast imaging,and in 12 cases via colostomy or exploratory laparotomy.Surgical treatment was performed in 25 cases,including 14 with fecal diversion,6 with total resection or mucosal stripping of the duplicated segment,and 5 with complete unification of the colonic tract.Follow-up (ranging from 2 months to 17 years) showed overall favorable outcomes in 20 cases. Conclusions Total colorectal duplication in children often presents with distinctive clinical features,such as defecation through a normally positioned anus accompanied by vestibular or urogenital fecal leakage in females and males,respectively,and mucosal prolapse during straining.Contrast imaging is typically sufficient for diagnosis and surgical planning.A surgical strategy comprising fecal diversion of the duplicated colon,correction of rectal duplication,and preservation of the anatomically correct anus yields reliable outcomes and favorable prognosis.
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Memo
收稿日期:2025-3-1。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com