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Management of perineal canal anomaly
1Department of Pediatric Surgery, The Institute of Child Health and The Children's Hospital, Lahore, Pakistan.
Insights
A rare congenital anomaly caused stool to pass through a girl's vulva. Surgical excision of the fistulous tract and a temporary colostomy successfully treated the condition.
Area of Science:
- Pediatric Surgery
- Medical Genetics
- Congenital Anomalies
Background:
- Congenital anomalies of the anorectum are rare, presenting unique diagnostic and management challenges.
- Vesicovaginal and rectovaginal fistulas can occur, but a fistula between the anal canal and the vaginal vestibule is exceptionally uncommon.
Observation:
- A 6-year-old female presented with a lifelong history of fecal matter expulsion via the vulva.
- Physical examination identified a fistulous tract connecting the vaginal vestibule to a normally developed anal canal.
Findings:
- The patient underwent surgical correction utilizing an anterior sagittal approach.
- A temporary defunctioning sigmoid colostomy was performed and successfully closed 12 weeks post-operatively.
Implications:
- This case highlights the importance of recognizing and surgically managing rare anorectal malformations.
- Successful treatment underscores the efficacy of the anterior sagittal approach for complex fistulas.
- Further research into the embryological origins of such anomalies is warranted.
Abstract:
A 6-year-old girl presented due to passage of stool through her vulva since birth. Examination revealed a fistulous tract between vestibule of the vagina and an otherwise normally formed anal canal. The tract was successfully excised through an anterior sagittal approach with a defunctioning sigmoid colostomy, which was closed 12 weeks later. The embryology, morbid anatomy, and treatment of this rare congenital anomaly are discussed along with a review of the literature.