Ann Surg Treat Res.  2014 Oct;87(4):213-216. 10.4174/astr.2014.87.4.213.

An accessory limb with an imperforate anus

• Park KB
• Kim YM
• Park JY
• Chung ML
• Jung YJ
• Nam SH

• KMID: 1882828
• DOI: http://doi.org/10.4174/astr.2014.87.4.213

Abstract

Congenital accessory limbs are very rare anomalies with many causative factors. We describe the case of a 1-day-old female neonate-born to a healthy, 27-year-old mother-who presented with an accessory limb (foot) attached to the buttock and an imperforate anus. We also provide a review of the relevant literature.

Keyword

Congenital; Imperforate anus; Limb deformities

MeSH Terms

Adult
Anus, Imperforate*
Buttocks
Extremities*
Female
Humans

Figure

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  Fig. 1 A 1-day-old neonate presented with a congenital accessory limb attached to the buttock below an imperforate anus.

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  Fig. 2 An oval-shaped ossified bone was observed on the left side of the end of the sacrum.

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  Fig. 3 A small round bone was located below the sacrum and a long bone was located below this small bone.

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  Fig. 4 Once excised, the accessory limb had a similar appearance to a normal neonatal foot, except for the fact that it only had 4 toes, with nails, which were bent towards the sole (A, B). The dissected surface indicated multiple bony structures that appeared similar to tarsal, metatarsal, cuneiform, talus, and malleolus bones. Skin and connective tissue were found to cover the bones (C).

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  Fig. 5 Under the microscope, the accessory foot was found to comprise ossified and nonossified bony structures, and the ossified bone had marrow space (A: H&E, ×20). Skeletal muscle bundles, vascular structures, and fat were found to cover the bones (B: H&E, ×40).

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  Fig. 6 An asymmetric buttock was noted on images obtained at the 8-month follow-up examination.

Reference

1. O'Shea MK, Pillman SH, O'Shea R. Congenital third foot deformity: a case report. J Foot Ankle Surg. 2008; 47:583–588.

2. Sharma L, Singh RB, Bhargava JS, Sharma VK. Accessory limbs with spinal lesions. Pediatr Surg Int. 1991; 6:227–229.

3. Akyol D, Baltaci V, Kozinoglu H, Yuksel K, Kis S, Cicek N, et al. Accessory limb attached to the back. Turk J Med Sci. 1999; 29:199–201.

4. Taniguchi K, Aoki Y, Kurimoto H, Okamura T. Baby with a third leg. J Pediatr Surg. 1975; 10:143–144.

5. Chadha R, Bagga D, Malhotra CJ, Dhar A, Kumar A. Accessory limb attached to the back. J Pediatr Surg. 1993; 28:1615–1617.

6. Rowe MI, Ravitch MM, Ranniger K. Operative correction of caudal duplication (dipygus). Surgery. 1968; 63:840–848.

7. Unterscheider J, O'Byrne J, Foran A, Robinson I, Ryan S, Devaney D, et al. Prenatal identification of an accessory lower limb. Prenat Diagn. 2011; 31:1203–1204.

8. Krishra A, Chandna S, Mishra NK, Gupta AK, Upadhyaya P. Accessory limb associated with spinal bifida. J Pediatr Surg. 1989; 24:604–606.

9. Verma S, Khanna M, Tripathi VN, Yadav NC. Occurrence of polymelia in a female child. J Clin Imaging Sci. 2013; 3:18.