Rectovestibular fistula associated with colonic atresia

A complete staged reconstruction has been performed on a 4-year-old girl with imperforate anus, rectovestibular fistula, and colonic atresia. The rectal remnant was a small 10 cm long segment, widely separated from the right colon. An end colostomy had been performed in the neonatal period elsewhere. Associated urinary anomalies were treated first. At the age of 4 years, distal colon remnant dilatations were started using a balloon catheter through the vestibular orifice. Four months later, end-to-end ascending colon-sigmoid anastomosis was done, after colonic mobilization and tapering. A temporary loop ileostomy was left at the left upper quadrant. Three months later a posterior sagittal anorectoplasty was successfully performed. At the age of 5 years she has achieved fecal continence, after the ileostomy closure.