Abstract
A ten months old male infant who has had tenesmus and abdominal distension since neonatal period was admitted for examination. Anorectal stenosis, 7 mm in diameter 3 cm from the anal orifice on the oral side was confirmed by digital examination, anoscope and barium enema. Since no evidence of rectourethral fistula was found in voiding cystography or barium enema, rectal dilation was applied for initial treatment. However during the rectal dilation, urinary tract infection appeared and then rectourethral fistula was confirmed by cysto-urethrography. A trans-anal or a trans-rectal approach for closure of the urethro-rectal fistula were both uneffective, and the fistula recanalized. Therefore, posterior sagittal approach with sigmoid colostomy was applied for radical operation. And closure of the rectourethral fistula, resection of the stenotic lesion of the rectum and anorectoplasty with rectal pull-through were performed. Postoperative course was uneventful, the patient restored normal defication over two-years follow-up period. In present case, posterior sagittal approach with sigmoid colostomy provided an excellent view and a successful treatment for closing the rectourethral fistula and resecting the stenotic lesion of intermediate rectum.
