Evaluation and Management of Rectoperineal Fistula in Male Children: An Observational Study

Anorectal malformation is an important congenital anomaly. Rectoperineal fistula (RPF) is one of the clinical types that fall in the rare/regional variants of the Krickenbeck classification. There is limited literature on this rare clinical type. This paper deals with its clinical presentation and the management protocol adopted by us. All patients of RPF were included. The patients were evaluated for age at presentation, the clinical presentation of the RPF, associated anomalies, and complications. After the diagnosis, all patients underwent three-stage surgery: diverting loop colostomy, posterosagittal anorectoplasty, and colostomy closure. During the study period of 10 years, we managed seven patients with RPF. The mean age of the patients at the time of first surgery and posterosagittal anorectoplasty was 2.71 days and 2.39 years, respectively. Four patients had puckered and pulled-up skin at the fistula. 2D ECHO was normal in all the patients. Ultrasound abdomen revealed an ectopic kidney and mild hydronephrosis in one patient each. The mean duration of follow-up was 3 years. All seven patients had completed all three stages of surgery. All of them have no soiling. Three patients had Grade 2 constipation. With treatment, they showed improvement, and they are in Grade 1 constipation. RPF is an uncommon variant of anorectal malformation. Any patient with a perineal fistula should be carefully examined to rule out RPF. If diagnosed, the management should be as per the rectourethral fistula. Overall outcome appears to be good.