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

• 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.

Takeaways

• 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.