Anterior rectal duplication treated with transanal endoscopic microsurgery

Excerpt

A 20-year-old female, without any medical or surgical history, was referred in our surgical department for chronic pelvic pain associated with episodes of bloody diarrhea and rectal tenesmus evolving since 2 years. Abdominal examination was unremarkable, whereas digital rectal examination found an anterior flexible lesion, measuring 4 cm and located 5 cm from the anal verge. A flexible rectosigmoidoscopy showed an anterior lesion without involvement of the rectal mucosa. On pelvic magnetic resonance imaging (MRI), this anterior rectal lesion was developed in the rectal wall without invasion of the fascia recti or rectovaginal septum. It resulted in low signal intensity on T1-weighted images and high signal intensity in T2-weighted images, with enhanced wall, suggesting a cystic lesion (Fig. 1a). No locoregional lymph nodes were observed. Endorectal ultrasound (ERUS) revealed that the cystic lesion had developed in the rectal wall and had its own wall with a submucosa and a muscularis. These ultrasound features were in favor of a rectal duplication (Fig. 1b).

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