How to approach cases of anal atresia with rectoscrotal fistula: Low or intermediate?

Abstract

Anorectal malformation is a congenital condition where the anus, which opens into the rectum, is missing, malformed, or has a blockage that does not allow feces to pass from the body. These malformations often present with an enteroperineal or enterourinary tract fistula in male children. Anorectal atresia with rectoscrotal fistula is rare. Herein, we present the case of a neonate with imperforate anus and a fistula on the scrotal raphe. A fistula in front of the scrotum, described in our case, is very rare and not incorporated in the current classification and treatment algorithms. Scarce reports on misjudgment concerning the position of the blind rectal pouch in similar cases, led us to perform a colostomy instead of a one-stage correction. We believe that in cases with a rare fistula presentation, the position of the rectal pouch is not predictable and the surgeon should proceed with caution.