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(A) Clinical appearance of ARM. (B) Infantogram. (C) Prone table lateral shoot through radiography showing distal bowel air shadow above PC line. (D) High sigmoid colostomy. (E and F) pressure augmented distal colography image showing a terminal colo vesical fistula.. (G) Proximal colon of normal caliber and length.
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Surprisingly, author found the presence of a terminal colo vesical fistula on electively planned distal loopgraphy, the non-dilated colon having normal caliber, width as well as length connecting to the normal size bladder having normal upper urinary tracts (Figure 1E-G).
(A) PSARP approach showing only bladder without any bowel or fistula, forceps pointing at posterior wall of bladder. (B) PSARP wound closed over red rubber tube. (C) Blue arrow pointing at - terminal colovesical fistula; sigmoid colon ending as a fistula in the posterior wall of the bladder between dome and trigone. (D) Opened terminal colovesical fistula over an infant feeding tube. (E) Anoplasty. (F) Colostomy closure.
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Hence tract was created in posteror sagital region and sphincter muscle complex was closed around the red rubber tube (Figure 2A, B). Abdomen opened through Pfannesteil incision where a normal redundant sigmoid bowel ending as a wide fistula, the terminal colovesical fistula of 2 cm in length and 05 cm width into the posterior wall bladder between dome and trigone without any trace of distal bowel or rectum (Figure 2C, D). The terminal colo vesical fistula was disconnected from the posterior wall of the bladder, and sigmoid colon was brought to perineum through previously made posterior sagitaal incision along the red rubber tube and anoplasty was done (Figure 2E). Baby is now three years old and passing normal stolls via neoanus uneventfully (Figure 2E, F).