Rectal Atresia With Anal Canal Atresia: A Pediatric Case

Abstract

The patient was a 9-month-old boy born by cesarean section after 38 weeks and 1 day of gestation, weighing 2,906 g with an Apgar score of 8/9 points (1 min/5 min). He was referred to our hospital at 1 day of age with suspicion of anorectal malformation. The anus appeared to be normal, but a closer examination revealed it to be closed and imaging showed it to be in an inverted position, leading to the diagnosis of a mid-protoanorectal malformation. A transverse colostomy was performed. Voiding cystourethrography and stoma angiography showed no fistula. An MRI scan at 6 months of age showed that the anal sphincter was intact and a right ectopic ureter was found. Because of recurrent urinary tract infections, vesicoureteral neostomy and posterior sagittal anorectoplasty (PSARP) were performed at 9 months of age. An anal-canal-like structure was observed between the rectal blind end and the anal dimple, and a dentate-line-like structure was observed in the internal cavity, but there was no continuity with the rectum, and the anal side was also closed. The anal-canal-like tissue was completely removed, and the rectal blind end was pulled down to create an anus. The tissue that was completely removed was histopathologically shown to be the anal canal. Although this case was atypical in terms of anal canal atresia, subsequent examinations led to the final diagnosis of rectal atresia with anal canal atresia. The postoperative course was good, and PSARP was useful in this case.