Posterior sagittal anorectoplasty for male H-type rectourethral fistula: A case report

Abstract

Introduction: H-type anorectal malformation (ARM) is a rare type defined as a congenital ano-recto-urogenital communication with an external anal opening in a normal or ectopic position. The management of male H-type ARM is controversial because of its rarity and diverse phenotypes. Excision or ligation of the fistula using the anterior perineal approach has mostly been selected for treatment in previous reports, but recurrence of the fistula is not uncommon. Case presentation: An 18-day-old boy presented to our hospital with abdominal bloating and bilious emesis. Anal stenosis was detected on examination. Dilatations by bougienage and enemas were initiated. He experienced urinary infections twice at within the following month. At seven months of age, his mother noticed gas and fecal discharge from his urethral opening. Retrograde cystourethrography and contrast enema revealed a rectourethral fistula, leading to the diagnosis of an H-type ARM. We did a rectal pull-through using the posterior sagittal anorectoplasty (PSARP) approach, with a sigmoid colostomy to minimize the risk of recurrence. The postoperative course was uneventful and there were no complications. The patient had good urinary function and defecation without fistula recurrence. Conclusion: Rectal pull-through with a PSARP seems to be an effective procedure for the management of male H-type ARM.

Keywords

• Anorectal malformation
• H-type rectourethral fistula
• Case report