Patient Case Discussion
Case Summary
OVERVIEW
This case presentation focused on a complex case of a 4-year-old female patient with a colorectal and neurogenital malformation, including a rectal vestibular fistula, complete double urinary tract, and grade 3 vesicoureteral reflux. The complexities of the patient's condition were explored in depth, with emphasis on the importance of additional imaging and studies to better understand the malformation. Concerns were raised about proposed treatments, and recommendations were made for further evaluation and surgical planning.
Complex Rectal and Neurogenital Malformation
The patient was initially diagnosed with a complex rectal malformation and underwent a cystoscopy, which revealed two separate bladder cavities and a single cervical canal. The surgical plan involved a cystoscopy to evaluate both urethras and bladders, followed by a posterior sagittal approach to correct the vestibular fistula. The patient's postoperative evolution was uneventful, and she is currently undergoing follow-up with the urology, orthopedics, and genetics teams for further evaluation and surgical planning.
Patient's Complex Malformation and Proposed Pubic Bone Fusion Concerns
Concerns were expressed about the proposed pubic bone fusion for the patient, questioning its benefits for walking and ambulation. It was suggested that the patient's urinary control and lack of reflux might mean the urinary tract should not be touched. Also emphasized was the importance of understanding the patient's complex malformation through a schematic diagram and not attempting to approximate the pubic bones. The presenter acknowledged the patient's urinary control and the need for further studies before deciding on a surgical plan.