- 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