Purpose or Case Report: Caudal duplication syndrome is a rare entity that involves duplication of various structures arising from the embryonic cloaca and notochord.

This presentation outlines the case of a 38-year-old G2P1 woman referred to our institution at 21 weeks gestation for anomalies detected on antenatal ultrasound. Antenatal ultrasound demonstrated sagittal duplication of the bladder, duplex phallus, a bifid scrotum and a horseshoe kidney. A subsequent fetal MRI confirmed those findings and also demonstrated apparent duplication of the colon and dysmorphic lumbosacral spine.

Following delivery, the baby passed urine via both urethras and meconium via a right-sided anus; there was a left-sided anal dimple with an imperforate anus. VCUG showed no communication between the two bladders. A colovesical fistula was demonstrated between the left bladder and colon, which is likely the redundant duplicated colon with the imperforate anus. MRI of the abdomen and pelvis showed a lipomeningocele with attempted sacral duplication, redemonstrated duplication of the pelvic organs, and confirmed absence of a left-sided rectum and sphincteric complex.

Caudal duplication syndrome is a complex malformation, the management of which often requires a multidisciplinary approach involving radiology, general surgery, urology, and neurosurgery. This case illustrates the findings of this rare entity with good correlation between fetal and postnatal imaging. It also highlights respective contributions of the various imaging modalities in guiding management, which usually entails staged surgical correction.

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