title: An unusual presentation of a rectal duplication cyst.
abstract: BACKGROUND
  Intestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Rectal duplication cysts account for approximately 4% of all duplication cysts. They usually present in childhood with symptoms of mass effect, local infection or more rarely with rectal bleeding from ectopic gastric mucosa.
  
  
  METHODS
  A 26year old male presented with a history of bright red blood per rectum. On examination a mucosal defect with an associated cavity adjacent to the rectum was identified. This was confirmed with rigid proctoscopy and CT scan imaging. A complete transanal excision was performed.
  
  
  CONCLUSIONS
  Rectal duplication cysts are more common in pediatric patients. They more frequently present with symptoms of mass effect or local infection than with rectal bleeding. In adult patients they are a rare cause of rectal bleeding. Definitive treatment is with surgical excision. A transanal, transcoccygeal, posterior sagittal or a combined abdominoperineal approach may be used depending on anatomic characteristics of the duplication cyst.
  
  
  CONCLUSIONS
  We present a rare case of a rectal duplication cyst presenting in adulthood with rectal bleeding, managed with transanal excision.
authors.affiliation: Department of General Surgery, University of Utah Hospital, Salt Lake City, UT 84132, USA.
authors.forename: Katharine L
authors.initials: KL
authors.lastname: Jackson
authors.forename: William J
authors.initials: WJ
authors.lastname: Peche
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rollins