PMC5762197_01
(
A
) Invertogram showing that the dilator contacted the air column in the distal intestine and the air-fluid levels at 28 hours of age. (
B
) Diverting sigmoid colostomy when the patient was 8 months old. (
C
) Distal cologram showing the rectal atresia without any fistula with an ~1.5 cm atretic gap.
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PMC5762197_01_10-1055-s-0037-1612610-i170353cr-1.jpg
FI170353cr-1
An upside-down invertogram was performed, and a Hegar dilator was passed through the anal opening, which revealed an air column in the distal intestine ( Fig. 1A ).  A diverting descending colostomy was performed on the second day of life ( Fig. 1B ). Before the operation, a distal colostogram revealed rectal atresia without any fistula, and the atretic gap length of the rectum was determined to be ~1.5 cm ( Fig. 1C ).
(
A
) Intraoperative image showing the patient in a prone position with the pelvis elevated for the posterior sagittal approach. The patient exhibited normal perineum, genitalia, and a normally located anal opening. (
B
) Exposure of the defect with a Hegar dilator in the distal pouch. (
C
) The fibrous tissue separating the two rectal pouches (the incision asymmetry is due to the asymmetric position of the instrument). (
D
) The upper pouch of the rectum is held with sutures and opened. (
E
) A simple end-to-end circumferential anastomosis with interrupted long-term absorbable sutures.
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PMC5762197_01_10-1055-s-0037-1612610-i170353cr-2.jpg
FI170353cr-2
The continuity of the rectum was established with circumferential anastomosis using interrupted absorbable sutures and a posterior sagittal approach ( Fig. 2A - E ).