PMC8320771_01
Preoperative photographs of the intermediate anorectal malformation with rectoperineal fistula.
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F1
ARM (Figure 1) who underwent colostomy creation in his native country. Antenatally, he had placental placement issues, which settled at 22 weeks' gestation.
(A) Distal loopogram showed a rectocutaneous fistula located at the anterior perineum. (B) Cystoscopy showed no obvious internal fistula with good stream on bladder compression. There was a reddish dot at 6-o'clock position on the posterior urethra.
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F2
Investigations included a distal loopogram, which showed a rectocutaneous fistula located at the anterior perineum (Figure 2). There was a reddish dot at 6-o'clock position at posterior urethra (Figure 2).
Intraoperative photographs demonstrating that a 1-mm rectoperineal fistula was noted externally and cannulated with a microprobe. On mobilization of the rectum, the rectal stump was found to be at the level of the bulbous urethra. A common wall was identified between the bulbous urethra and the fistula tract extending for 3 cm. The bulbous urethra was inadvertently laid open during separation of the common wall. Subsequently, urethroplasty was done in two layers, and anoplasty was completed.
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F3
Subsequently, the patient underwent anorectoplasty and urethral repair (Figure 3).
PMC8320771_02
Ultrasound of the kidneys, ureter, bladder, and perineum demonstrated a dilated left pelvicalyceal system. There was a distal rectal pouch to the perineum that measured 12 mm.
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F4
Ultrasound of the kidney, ureters, bladder, and perineum showed a dilated pelvicalyceal system (Figure 4).
The baby was initially planned for perineal anoplasty on day 2 of life. It was noted there was a fine, long cutaneous track running in the scrotal raphae in close proximity with the bulbar urethra extending all the way to the base of the penis. The bulbar urethra was inadvertently entered during separation of the thin common wall. This was repaired in two layers. Anoplasty was then performed.
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F5
ARM with perineal fistula with opening at scrotal raphe creating a bifid scrotum (Figure 5). A fine, long cutaneous track running in the scrotal raphe was in close proximity with the bulbar urethra extending all the way to the base of the penis.