Rectal atresia managed by anterior anal canal preserving posterior sagittal approach: A case report

Introduction: Rectal atresia is a rare form of anorectal malformation characterized by a normally developed anal canal and sphincter complex; however, despite this favorable anatomy, the optimal surgical approach remains controversial. Case presentation: A 2-year-old male child was diagnosed with anorectal malformation on the second day of life after failure to pass meconium and abdominal distension and initially underwent a divided descending sigmoid colostomy with a distal mucous fistula. Preoperative assessment revealed no associated anomalies, with normal renal ultrasonography, echocardiography, and spinal evaluation. Perineal examination showed a normally positioned anus with good sphincter tone, and digital rectal examination demonstrated a blind-ending rectum approximately 5 cm from the anal verge. A distal colostogram confirmed rectal atresia without evidence of a presacral mass. Definitive repair was performed using an anterior anal canal–preserving posterior sagittal approach, revealing a membranous rectal atresia. The posterior rectal wall was mobilized and sutured to the posterior edge of the sphincter muscle complex. Stoma closure was completed three months later. At two years of follow-up, the child demonstrated excellent functional outcomes with voluntary bowel movements and good continence. Conclusion: The anterior anal canal preserving posterior sagittal approach seems to be safe and effective for rectal atresia, providing excellent functional outcomes.