11-Month-Old Female Patient with Scabies and Imperforate Anus with Fistula Discovered During Hospitalization

Case Summary

• Patient presents for evaluation. She is an 11-mo-old female patient from Panama. She had an out of hospital delivery. She has no surgical history. Mother is currently pregnant again. Patient is exclusively breast fed.
• She had loose stool daily and her weight is 6.1 kg.
• Medical team is in Costa Rica so there is a language barrier and barrier due to the location.
• Baby was admitted to the hospital with bronchiolitis.
• During hospitalization, she was identified to have scabies and anorectal malformation.
• On exam, the patient had a perineal fistula located near the vagina. The fistula is located anterior to the sphincter. She had a well-formed gluteal crease. The fistula calibrated with a size 8 Hegar.
• Abdominal ultrasound was normal.
• Baby did not have a congenital cardiac condition. An abdominal radiograph suggested that the sacrum may not be normal.
• Surgical options include operating in Costa Rica after the respiratory symptoms subsided. This option would be challenging because of separation from family and future of bowel management.
• Another option would be to transfer to Panama but there may be problems with the border coordination.
• The third option would be dilations with a Hegar 14.

Takeaways

• This perineal fistula will likely require surgical intervention due to the proximity to the vagina and very short perineal body. For these reasons, dilations would not be an ideal treatment.