Colorectal duplication with rectourethral fistula mimicking Hirschsprung disease: a rare pediatric case report from Northwest Ethiopia

Background Alimentary tract duplications are rare congenital anomalies that may occur anywhere along the gastrointestinal tract. Colorectal duplications represent a small proportion of these anomalies and may present with nonspecific symptoms that mimic other gastrointestinal disorders. Association with rectourethral fistula is extremely uncommon and can further complicate diagnosis. Case presentation We report the case of a 2-year-old male child from Northwest Ethiopia who presented with chronic constipation, abdominal distension, failure to thrive, and recurrent urinary tract infections. The child later developed pneumaturia and fecaluria. Imaging studies, including contrast enema and voiding cystourethrography, suggested Hirschsprung disease with a rectourethral fistula. Surgical exploration revealed a duplicated sigmoid colon and rectum. The duplicated rectum terminated in the native anorectum just proximal to the dentate line and was associated with a rectourethral fistula located approximately 5 cm from the anal verge. The patient was managed with staged surgery consisting of diverting colostomy, excision of the duplicated colorectal segment, pull-through reconstruction, and fistula repair. Histopathologic examination confirmed colorectal duplication. The postoperative course was uneventful with marked improvement in nutritional status and bowel function. Conclusions Colorectal duplication should be considered in children presenting with refractory constipation, pelvic mass, or atypical urogenital symptoms. The presence of pneumaturia or fecaluria should raise suspicion for an enterourinary fistula. Early diagnosis and complete surgical excision provide definitive treatment and excellent outcomes.