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

Case 51

Clinical History:
The patient was a full term female with multiple congenital anomalies including VACTER, situs inversus, atrial septal defect, cleft mitral valve, interrupted inferior vena cava, hepatic veins emptying directly into the heart, small ventricular septal defect, scoliosis, Klippel-Feil syndrome including webbed neck / scapula and cervical anomalies, and choanal atresia / stenosis.

Clinical Physical Exam:
Anal atresia with rectovaginal fistula to the vaginal fourchette. The patient stools via constant dilation of the fistula.

Images 1, 2, and 3

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Anorectal malformation (low)

Imaging Findings:
A chest film from the first day of life showed some of the congenital anomalies. An ultrasound exam of the abdomen from the next day showed a stool filled rectal pouch, azygous continuation of the inferior vena cava, and normal kidneys.

Image 4

Image 5

Image 6

Imaging Differential Diagnosis:
The ultrasound measurements did not allow a determination between classifying this as a high or low anorectal malformation.

Operative Findings:
At 9 months of age the patient underwent a posterior sagittal anorectoplasty and division of the rectovaginal fistula.

Pathological Findings:
None

Final Diagnosis:
Anorectal Malformation (Low)

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 28, Case 35

References:

• Paediapedia

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