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Caudal Duplication Syndrome in a Young Girl: A Complex Case of Gastrointestinal and Genitourinary Duplication with Spinal Dysraphism
Muhammad Saleem 1, umer saleem 2, asfand yar ali 3, Jamaal Butt 3, Nabila Talat 3, muhammad qasim Sher khan 1, ashar bin dawood 1, Azka Saleem 3, Ghulam Mohyudin 4
1 Akhtar Saeed Medical & Dental College, Lahore
2 services institute of medical sciences lahore
3 University of child health sciences, The Childrens Hospital, Lahore
4 Fatima Memorial Hospital Lahore
Introduction:
Caudal Duplication Syndrome (CDS) is an exceedingly rare congenital anomaly characterized by duplication of the distal gastrointestinal, genitourinary, and neural structures. We present a complex case of a 6-year-old female, diagnosed at birth with classical features of CDS and managed by us.
Case Presentation:
Initial findings included omphalocele, lumbosacral swelling (myelomeningocele), duplicated anus and urinary openings, and double vagina which were 6 cm apart. Imaging and surgical exploration confirmed duplication of the bladder, urethra, colon, and vaginal structures. Associated anomalies included rectovesical fistula, tethered cord, diastematomyelia, malrotation of midgut, thoracolumbar hemivertebrae.
Multiple staged interventions were performed, including lipomeningocele repair, bladder unification, left colectomy, omphalocele closure, and left urethral occlusion. Despite these, persistent urinary dribbling from a left urethral fistula and neurogenic bowel remains a major issue to be addressed.
Patient has no voluntary bladder or bowel control, continuous urinary leakage and risk of renal system deterioration especially on left side proved by recent renal scan and MCUG. She has para paresis with grade 2 power and walks with support.
A detailed management including Clean Intermittent Catheterization (CIC), and anticholinergics is going on. If needed in future depending on bladder dynamics, bladder augmentation ± Mitrofanoff and left urethral fistula closure is in planning. Bowel management and potential MACE, along with evaluation by pediatric gynecology and physiotherapy, are part of ongoing care.
Conclusion:
This case underscores the importance of individualized, multidisciplinary care in CDS to preserve renal function, achieve continence, and improve quality of life.