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Congenital anal fistula with normal anus
H Brem1, F M Guttman, J M Laberge
1Department of Pediatric Surgery, McGill University and Montreal Children's Hospital, Quebec, Canada.
Insights
This study reports on three infants with congenital fistulas. The male patient
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Congenital fistulas in infants can present diagnostic challenges.
- Anovestibular and perineal fistulas are rare congenital malformations.
- Previous literature primarily describes urethral fistulas in males.
Observation:
- Three pediatric cases of congenital anovestibular/perineal fistula were treated.
- Two female infants presented with symptomatic anovestibular fistulae early in life.
- A male infant presented with a chronically draining congenital perineal fistula.
Findings:
- Surgical excision of the perineal fistula in the male infant was successful.
- Microscopic analysis revealed intact rectal mucosa within the fistula tract.
- This case represents the first reported male infant with a congenital perineal fistula.
Implications:
- Congenital perineal fistulas may be underreported in male infants.
- This finding suggests a potential congenital etiology for some fistula-in-ano cases in males.
- Early diagnosis and surgical intervention are crucial for managing these congenital anomalies.
Abstract:
Three patients with a congenital anovestibular/perineal fistula were treated at the Montreal Children's Hospital. Two females (one of East Indian and the other of Japanese origin) had anovestibular fistulae that became symptomatic in the first few months of life. The third patient, a boy of Korean descent, presented at 9 months of age with a chronically draining perineal fistula. During surgery, a small fistula tract was easily dissected out and excised. Microscopic examination showed a well-preserved rectal mucosa throughout the tract. Most male patients described to date had anourethral fistulae, often accompanied by other major anomalies such as esophageal atresia or renal malformations. We believe our patient is the first male to be described with a congenital perineal fistula; this suggests that some fistula-in-ano in male infants may be due to a congenital sinus that secondarily becomes infected and drains to the skin.