Imperforate anus with long but apparent low fistula in females

Despite the low entry of the rectum into the vagina in some females with imperforate anus, the fistula may be deceivingly long. This variation should alert the surgeon to measure the fistula prior to anoplasty. During surgery, biopsies of the mobilized segment should also be done to assure that cloacal-transitional lined structures have been removed and rectal mucosa anastamosed to the perineum.