Treatment of adult congenital anal atresia with rectovestibular fistula: A rare case report

Abstract

Background: Female anorectal malformation is a correctable congenital defect. Delayed manifestations in patients with anal deformities are uncommon, especially after adolescence.

Case summary: The clinical data of a 19-year-old adult female patient with congenital anal atresia accompanied by rectovestibular fistula as the main manifestation was retrospectively analyzed. Diagnosis was made based on the patient's clinical symptoms, signs, imaging showing the fistula, X-ray and magnetic resonance imaging results. The preoperative examination was improved. Anorectoplasty was performed. The patient exhibited an improvement in quality of life and presented no evidence of fecal incontinence during the 6-mo follow-up.

Conclusion: Transfistula anorectoplasty is a reasonable and reliable surgical method for the treatment of adult congenital anal atresia and rectovestibular fistula.

Keywords: Anorectal malformations; Case report; Congenital anorectal atresia; Rectovestibular fistula; Transfistula anorectoplasty.

Figure 1

Preoperative physical examination, imaging examination, operation process and postoperative follow-up were performed in this case. A: The vestibular fossa shows a defecation fistula, the position of the vagina, the urethral opening and the position of the fistula; B: Abdominal computed tomography showed rectal dilation with intestinal wall thickening, with a maximum diameter of approximately 10 cm; C: X-ray: The distal end of the rectum was blind, approximately 6 cm from the anal notch; D: Pelvic magnetic resonance imaging (MRI) cross-section closed the upper segment of the anal canal space, not completely closed; E: Pelvic MRI coronal view showed that the thickness of the internal sphincter was approximately 1 mm, part of the internal sphincter was discontinuous, and the thickness of the external sphincter was approximately 2 mm; F: Pelvic MRI sagittal view shows the position of the rectum, vagina and fistula, and the fistula is adjacent to the posterior wall of the vagina; G: Opening of the atretic anal canal reveals lacunae and muscle fibers; H: Free the fistula and rectum, pay attention to protect the superficial perineal striated muscle and the central tendon of the perineum, and carefully separate it from the posterior wall of the vagina to avoid causing damage to the vagina; I: Reconstruction of the vagina and perineal body, repair of vestibular wounds, intermittent suture of the space between the posterior wall of the vagina and the central tendon of the perineum, intermittent suture of the bulbospongeus muscle, counterposition suture of the vestibular mucosa and submucosal tissue, repair of the hymen. The whole end of the new rectum was sutured to the subcutaneous dermis of the anus; J: Pathology: Moderate chronic inflammation of the mucosa, loose and swollen submucosa, and congestion of the gut wall; K: At the 2-mo follow-up, the rectal mucosa was slightly retracted; L: At the 4-mo follow-up, the rectal mucosa was almost retracted. IAS: Internal sphincter; EAS: External sphincter.