Anorectal Malformation in Males

Case No. 22: Anorectal Malformation In Males

It might be a Perineal fistula, a Rectourethral fistula ( Recto bulbar or Recto prostatic), Recto bladder neck fistula, an imperforate anus without fistula or Rectal atresia.
Diagnosis is done by a cross-table Lateral invertogram (done to access the level of the fistula). It should be performed 18-20 hours after the birth of the child.
Perineal fistula can be treated by a “Cut back anoplasty” 18-24 hours after birth or a limited PSARP. It is a single-staged procedure.
Higher fistulas require a 3 staged procedure
A. Colostomy at birth. After the lateral pronogram.
B. Posterior sagittal ano rectoplasty (PSARP) at 2-4 months of age or when the child is more than 4kgs.
C. Colostomy closure around a month after the PSARP.
An anal dilatation programme should be followed for a year after the surgery.
Associated CVS, GI, Spinal or vertebral and renal anomalies should be ruled out.