A Case of Anorectal Malformation With Idiopathic Rectal Perforation in a Neonate

Abstract

The patient was a 0-day-old boy. He was born without an anus in a nearby hospital and diagnosed with anorectal malformation (ARM); thus, he was taken to our hospital 2 h after birth. He was subjected to invertogram and urethrocystography 22 h after birth and diagnosed as having low ARM without a fistula. He was subjected to invertogram again to confirm the distance of dimple to the rectal blindness edge 40 h after birth, and perineal anal formation was performed 44 h after birth. His postoperative course was good, but his CRP level on the first day of looking unwell was 11.4 mg/dl, and abdominal distension gradually developed. Abdominal X-ray suggested the presence of free air in the peritoneal cavity, and he was operated for gastrointestinal perforation. In the operation fields of view, perforation was found in the anterior wall of the rectum above the peritoneal reflection, and an interruption in the circulation in part of the perforation was detected. We sutured the perforation, performed colostomy, washed the abdominal cavity, and inserted a drain tube. Free air was already found to exist in the second invertogram when we reviewed an X-ray image after operation. It is necessary to recognize that ARM can possibly lead to idiopathic rectal perforation.