Isolated rectal duplication

Isolated rectal duplication is a rare congenital malformation in which an additional tubular or cystic structure lined by intestinal mucosa is found adjacent to the rectum, without other associated gastrointestinal duplications or systemic anomalies. It belongs to the broader category of alimentary tract duplications but is distinguished by its isolated occurrence in the rectal region. The duplicated segment typically shares a common muscular wall or blood supply with the native rectum and may be located in the presacral or retrorectal space. Clinical presentation varies depending on the size and type of the duplication. Many cases are detected in infancy or early childhood, though some remain asymptomatic until later in life. Key symptoms may include rectal bleeding, constipation, recurrent perianal or pelvic infections, a palpable presacral or perianal mass, and difficulty with defecation. In some cases, the duplication may become complicated by infection, obstruction, or rarely malignant transformation of the mucosal lining in adulthood. Diagnosis is typically established through imaging studies including pelvic ultrasound, MRI of the pelvis, and contrast studies, sometimes supplemented by endoscopic evaluation. The standard treatment is surgical excision of the duplicated segment, which is generally curative. The surgical approach depends on the size, location, and relationship of the duplication to surrounding structures, and may range from a posterior sagittal approach to transanal or laparoscopic techniques. Long-term prognosis after complete surgical removal is excellent, with low recurrence rates when the duplication is entirely resected.

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