Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 35

Clinical History:
This one day old full term male was noted to have an absent anal orifice in the newborn nursery. He was observed to excrete meconium through his urethra at the tip of his penis.

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Clinical Physical Exam:
No anal orifice was seen.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Anorectal malformation (High)

Imaging Findings:
An abdominal film from the first day of life showed diffuse bowel dilation. A spinal ultrasound from the second day of life (not provided) showed the spinal cord conus to be normally positioned at L1. An echocardiogram (not provided) demonstrated double outlet right ventricle.

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Imaging Differential Diagnosis:
Low bowel obstruction

Operative Findings:
On the second day of life, the patient was taken to the operating room. Electrical stimulation of the perineal tissues revealed strong muscular contractions suggesting excellent anal sphincters for later reconstruction. A small lower midline abdominal incision was made and the mid sigmoid colon was brought out through a colostomy in the left lower quadrant.

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Pathological Findings:
None

Final Diagnosis:
Anorectal Malformation (High)

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. He underwent partial cardiac repair and had stable cardiac function. At 16 months of age a barium enema was performed for surgical planning before the definitive repair. Three weeks later the patient returned to the operating room and had a posterior sagittal anorectoplasty and a repair of the rectourethral fistula.

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Similar Cases:
Case 28, Case 51

References:

• Paediapedia

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