Double appendix and anorectal malformation: A case report

Double appendix, also known as vermiform appendix duplex, is a rare congenital anomaly. It is estimated to occur in 1 in 25,000 people with fewer than hundred cases reported worldwide. A 10-year-old boy presented to our clinic with fecal incontinence. He had a history of an anorectal malformation (recto = bladder neck fistula), for which he had undergone a neonatal anorectoplasty with an abdominal approach. The patient was not on any bowel management program. A plan of daily enemas, toilet training, and dietary measures including a high fiber and low carbohydrate diet was started. Despite following this program, his fecal incontinence persisted. The patient subsequently underwent a laparoscopic-assisted Malone appendicostomy without complications. During the operation, two cecal appendices were found. One appendix was removed, while the other one was used for the Malone appendicostomy. His postoperative course was uneventful. The patient currently does antegrade enema twice daily and his incontinence has completely resolved. Double appendix, although very uncommon, can be found in patients with anorectal malformations.