PMC9904968_01
Physical exam reveals rudimentary genital folds, which, when retracted, reveal a small, single perineal opening. There is no anal opening, but there is a gluteal fold with a dimple at the site of anal sphincter.
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The physical examination showed rudimentary genital folds with a single perineal opening, no anal opening, and a gluteal fold with a dimple at the site of the anal sphincter ( Fig. 1 ). The VACTERL workup was negative except for an atretic right kidney and left grade IV vesicoureteral reflux.
The cloacagram shows an atretic common channel, an atretic urethra, a single small vagina, and a rectum below the pubococcygeal line.
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A cloacagram showed an atretic common channel, a single small and high vagina, and a rectum below the pubococcygeal (PC) line ( Fig. 2 ). 
For a rectal patch, the megarectum is divided longitudinally with care to preserve its blood supply.
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For the rectal patch creation, we cut a rectangle from the anterior rectal wall based on the two perforating mesenteric vessels on either side ( Fig. 3 ).
The neovagina is reconstructed using the rectal patch, shown here being tubularized over a Hegar dilator. The patch was sutured to the wall of the vagina circumferentially. A 24-French Foley catheter, used for calibration of the rectoplasty, is seen in the rectum.
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We made sure the distal extent reached to the area of the clitoris and was healthy and viable ( Fig. 4 ). 