Serviço de Cirurgia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
4th World Congress of Pediatric Surgery, 13 a 16 de Outubro 2013, Berlim.
Anorectal malformation with vaginal fistula is an extremely rare entity. It usually presents as vaginal passage of meconium in a patient with imperforated anus, with no visualization of the fistula site by separating the labia minora. It is commonly associated with other genito-urinary malformations. We present two cases of anorectal malformation with vaginal fistula.
Retrospective revision of girls with anorectal malformations with vaginal fistula treated in our institution from January 2002 to March 2013. Evaluation of the clinical and imagiological presentation and post operative outcomes.
Two patients had a vaginal fistula. Both girls presented in the neonatal period with vaginal passage of meconium and in both a colostomy was done in the neonatal period. There was no prenatal diagnosis in either. Case 1 had an associated diaphragmatic hernia corrected in the neonatal period and a tethered spinal cord diagnosed later. No fistula was identified at inspection or in the colostogram. Intra-operatively a low vaginal fistula was detected and a posterior sagital anorectoplasty (PSARP) was performed. Anal dilatation was started two weeks after PSARP and no obstipation has been observed. Continence can not be evaluated yet due to patient's age.
Case 2 was transferred to our institution after neonatal colostomy and colostogram that was suggestive of vestibular fistula. On inspection no fistula was apparent. Intra-operatively a low vaginal fistula was detected associated with a vaginal longitudinal septum and didelphos uterus (in vaginoscopy). Patient was treated with a PSARP, after which anal dilatations were initiated. Intestinal function is normal with no obstipation. Continence can't also be evaluated due patient's age.
Although extremely rare or described as non-existent in the literature, vaginal fistulas were found in two patients in the last ten years. We believe PSARP is an adequate approach for this patients with an aparent favorable outcome.