10-Month-Old Female Patient Born with Anorectal Malformation Complicated by Dehiscence and Stricture

Andrea Bischoff, M.D.
Assistant Director, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO USA

  • 10-month female patient presents for evaluation.
  • She was born with anorectal malformation and underwent repair that was complicated by dehiscence and stricture.
  • Procedures that the patient underwent before referral to Colorectal Center: resuturing of the perineal body, colostomy and resuturing of the anoplasty and multiple anal dilation under anesthesia with injection of Kenalog.
  • Patient has a normal sacrum and normal kidneys.
  • On physical exam, urethra and vagina were intact.
  • Perineal body was nearly absent.
  • Anus was strictured only accommodated a size 9 Hegar dilator and mislocated.
  • Patient was most likely born with a perineal fistula.
  • Posterior sagittal anorectoplasty was performed.
  • Lonestar retractor with hooks was used to help with visualization.


  • Indications for reoperation include mislocation of the anus, absent perineal body and stricture.
  • Colostomy versus no colostomy is often debated. Both options are correct as long as the surgery is done well.
  • Anal dilations are indicated following surgery to maintain the size of the anus while the anoplasty heals.
  • Stricture often occurs as a result of ischemia and tension on the anoplasty.


Patient Case Discussion

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