Posterior sagittal anorectoplasty for a recto-urethral fistula on a 14-year-old boy: a case report

Anorectal malformations (ARMs) are typically diagnosed and managed during infancy. Delayed treatment in adolescents is exceptionally rare. A 14-year-old boy from a rural area was seen at our pediatric surgery unit with a sigmoid colostomy placed during the neonatal period. He had been lost to follow-up since the neonatal discharge. On examination, he was well-nourished and weighed 46 kg. He had no anal opening, but his gluteal muscles were well developed, the intergluteal cleft was prominent, and an anal dimple was present. A distal colostogram demonstrated a mildly dilated rectum terminating just below the sacrum, and a rectobulbar urethral fistula. His sacral ratio was 0.78. He was taken to the operating room for an elective posterior sagittal anorectoplasty (PSARP). Electrocautery mapping of the sphincter complex guided a midline posterior sagittal incision from the sacrum to the anal dimple. We ligated and repaired the rectobulbar urethral fistula with interrupted 4-0 reabsorbable braided sutures. The rectum was mobilized, tapered to fit tension-free within the sphincter complex, and the neoanus was positioned centrally. The colo-cutaneous anastomosis was fashioned with sixteen interrupted 3-0 reabsorbable braided sutures. The postoperative course was uneventful. Anal dilations began on postoperative day 14 and continued for three months, achieving an adequate anal caliber. The colostomy was closed safely in the fourth postoperative month. He is currently fully continent. Posterior sagittal anorectoplasty seems to be an effective approach for the repair of anorectal malformations in teenagers who had not had the repair done during infancy.