Colorectal duplication with prostatorectal fistulae ☆,☆☆ Mamta Sengar, Chhabi R. Gupta, Vishesh Jain ⁎ , Anup Mohta Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India 110031 Received 28 September 2012; revised 25 November 2012; accepted 15 December 2012 Key words: Colonic duplication; Tubular colonic duplication; Prostatorectal fistula; Gastrointestinal duplication Abstract Tubular colonic duplications are rare malformations and its association with prostatorectal fistula is extremely rare with only one case reported to date. We report the successful management of an 8 year old child with communicating tubular colonic duplication with prostatorectal fistulae. Tubular colonic duplications may be difficult to diagnose due to varied presentations, therefore a high degree of suspicion should be present while managing children with isolated congenital recto urinary fistulas. © 2013 Elsevier Inc. All rights reserved. Gastrointestinal tract duplications are rare congenital anomalies which can occur anywhere along the alimentary canal from the tongue to the anus [1]. Duplication of colon accounts for 13% of all gastrointestinal tract duplication [1]. We present an unusual case of communicating colorectal duplication with prostatorectal fistulae successfully managed by us. 1. Case history An 8 year old boy presented to us for the first time with the complaint of constipation since birth. Constipation was relieved partially after episodes of fecaluria. The child also suffered from recurrent urinary tract infections and rectal prolapse. There was no history of trauma or inflammatory disease in the perineum. On general examination, patient was found to have minimal scoliosis and an extra thumb in his left hand. There were no abnormal findings on abdominal, perineal and digital rectal examination. Based on history and examination, a provisional diagno- sis of H/N shaped recto urethral fistula was made. A high loop sigmoid colostomy was performed for the symptomatic relief till patient could be investigated prior to definitive management. After performing the colostomy, the episodes of fecaluria ceased, however, the patient started passing urine through rectum. Voiding cystourethrogram (VCUG) revealed presence of two lateral diverticulae in the posterior urethra. Distal colostogram with water soluble contrast was suggestive of a prostatorectal communication. Cystourethroscopy revealed two large diverticulae in prostatic urethra just lateral to the verumontanum on either side of it (Fig. 1). When the cystoscope was negotiated into the diverticulae, multiple openings were noted. Passage of fine ureteric stents into these openings confirmed their communication with the rectum. After leaving a stent in one of the fistulae, the patient was turned prone in jack knife position with the plan of dividing the recto urethral fistula though the posterior sagittal approach. On examination under anesthesia, multiple large fistulous openings were seen in the anterior wall of the rectum, approximately one centimeter from the anal verge. There was another opening in the colorectum on the posterior ☆ Source(s) of support: Nil. ☆☆ Conflicting Interest (If present, give more details): Nil. ⁎ Corresponding author. Tel.: + 91 09540951519; 01132531393. E-mail address: dr.vishesh79@gmail.com (V. Jain). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2012.12.032 Journal of Pediatric Surgery (2013) 48, 869–872