A Case of Rectal Atresia in a Female Neonate Treated With Single-stage Transanal Repair

Abstract

A 2-day-old female neonate was transferred to our institution because of progressive abdominal distension, poor activity, and vomiting since birth. She was born at 39 weeks and 6 days of gestation with a birth weight of 2,790 g, and no prenatal abnormalities were identified. Although the external appearance of the anus was normal, insertion of a Nelaton catheter was unsuccessful. Ultrasonography demonstrated a blind-ending rectum located just proximal to the anal verge, leading to the diagnosis of rectal atresia. Ultrasonographic evaluation revealed that the distance between the anal verge and the distal rectal pouch was 8 mm, and the gap between the distal and proximal rectal segments was approximately 1 mm. Given the short distance between the rectal segments, a single-stage transanal repair was considered feasible. During surgery, a transanal approach was employed. After incision of the perianal skin at the anal verge, the distal rectal pouch was identified and secured. The rectal lumen was then opened, and an end-to-end anastomosis between the rectum and the anal canal was performed. The postoperative course was uneventful. At 18 months of follow-up, the patient demonstrated satisfactory bowel function without evidence of bowel obstruction or incontinence. Although staged surgery is frequently selected for the management of rectal atresia, this case suggests that a carefully selected patient may be successfully treated with a single-stage transanal approach, which can be an effective therapeutic option.