Congenital rectovesical fistula in the absence of imperforate anus

Two neonates with multiple congenital anomalies presented with contamination of the urinary tract with fecal organisms. Both patients had normal anorectal areas but in both, a work-up of the urinary tract infection including cystogram and barium enema revealed a rectovesical fistula. This is highly unusual and as far as can be determined, no reports similar to this could be found. Patient 1 succumbed from severe cardiovascular disease after colostomy so that no further diagnostic or therapeutic measures could be taken. Patient 2 underwent sigmoid colostomy to divert the fecal contamination of the bladder. He then underwent successful surgical division of the rectovesical fistula from an abdominal approach and subsequently had his colostomy closed. Intraoperatively, a catheter placed in the fistula via the rectum was quite helpful in identification of the fistula. This very unique lesion in this second patient was one of a constellation of anomalies including megalourethra, epispadiac urethral fistula, undescended testes, bilaterally, a floppy lower abdominal wall, and absent left kidney. This patient could be construed as a variant of the prune belly syndrome.