High rectal atresia anastomosed using magnets: A case report

Surgical access to anorectal malformations (ARM) can be difficult from abdominal, perineal and transanal approaches. We present a case in which magnetic compression anastomosis was successfully employed to achieve a minimally invasive repair of high rectal atresia in a neonate. A female neonate born at 38 weeks and 5 days with no significant antenatal history and failure to pass meconium in the first 48 hours after birth developed abdominal distension and bilious vomiting on the third day of life. The patient was found on clinical examination and contrast enema to have rectal atresia just below the peritoneal reflection. A diverting colostomy was fashioned on day four of life. A distal colostogram at two months of age confirmed the diagnosis of high rectal atresia with minimal separation between the atretic ends. Magnetic compression anastomosis by insertion of a pair of magnets through the anus and mucous fistula was attempted to obviate the need for invasive surgery. Following a failed first attempt at the age of 11 months, a second attempt performed at the age of 15 months under endoscopic and fluoroscopic guidance successfully established luminal continuity. The colostomy was closed at the age of 16 months following a single topical application of mitomycin C. The patient recovered well and has excellent anorectal function three years postoperatively. Selected cases of rectal atresia may be treated by magnamosis. Fluoroscopic and endoscopic guidance may be required to ensure appropriate positioning of the magnets.