Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
This one day old full term male was noted to have an absent anal orifice in the newborn nursery. He was observed to excrete meconium through his urethra at the tip of his penis.
Clinical Physical Exam:
No anal orifice was seen.
Clinical Differential Diagnosis:
Anorectal malformation (High)
An abdominal film from the first day of life showed diffuse bowel dilation. A spinal ultrasound from the second day of life (not provided) showed the spinal cord conus to be normally positioned at L1. An echocardiogram (not provided) demonstrated double outlet right ventricle.
Imaging Differential Diagnosis:
Low bowel obstruction
On the second day of life, the patient was taken to the operating room. Electrical stimulation of the perineal tissues revealed strong muscular contractions suggesting excellent anal sphincters for later reconstruction. A small lower midline abdominal incision was made and the mid sigmoid colon was brought out through a colostomy in the left lower quadrant.
Anorectal Malformation (High)
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. He underwent partial cardiac repair and had stable cardiac function. At 16 months of age a barium enema was performed for surgical planning before the definitive repair. Three weeks later the patient returned to the operating room and had a posterior sagittal anorectoplasty and a repair of the rectourethral fistula.
Images 5 and 6
Case 28, Case 51
Follow us on Twitter @pedseducation and @pedsimaging
Please send us comments by filling out our Comment Form.
All contents copyright © 1992-2016 Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. and the authors. All rights reserved.
"Virtual Pediatric Hospital", the Virtual Pediatric Hospital logo, and "A digital library of pediatric information" are all Trademarks of Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.
Virtual Pediatric Hospital is funded in whole by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Advertising is not accepted.
Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.
The information contained in Virtual Pediatric Hospital is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.