Late diagnosis of congenital anal canal stenosis. Case report and literature analysis
- Gastroenterology & Hepatology: Open Access
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Michael D Levin, MD, PhD, DSc,1
Gad
Mendelson MD2
Abstract
We describe a case of congenital stenosis in the anal canal (ACS) in an elderly woman
who suffered from severe constipation since early childhood. Digital examination revealed
a thin membrane in the anal canal with an opening through which only the index finger
could fit. An X-ray examination revealed a narrowing in the anal canal at 1.9 cm from
the normally formed anus. The Foley catheter balloon was stuck above the membrane.
We found only one article describing delayed diagnosis of congenital rectal stenosis in
a 17-year-old adolescent. But she also had a membrane in her anal canal. A PubMed
search identified 14 articles that published radiographic studies of rectal atresia and rectal
stenosis in children. In all cases radiometric analysis revealed atresia or stenosis not in the
rectum, but in the anal canal. In 8 cases it was possible to determine the exact location of
the membrane. It was located approximately 1 cm from the anal verge. Conclusion. An
analysis of articles proved that in all cases the membrane was not in the rectum, but in the
anal canal. This discovery allows the membrane to be excised through the anal approach
without damaging the anal canal and the innervation of the anorectal area. It has been
shown that in a significant number (≈5%) of children with functional megacolon, ACS
may be the cause of the pathology. Scientifically based methods for diagnosing and treating
ACA/ACS are proposed. The localization and form of the defect suggests that it occurs
in the embryonic period due to a violation of the rupture of the membrane in embryos
13.5–135 cm long.
Keywords
rectal atresia; rectal stenosis; anal canal atresia; anal canal stenosis; anorectal malformations; embryology.
