Imperforate Anus

Imperforate anus is caused by failure of the descent of the urorectal septum. High versus low imperforate anus is determined by where the rectum ends, above or below the levator ani. There is a high incidence of associated genitourinary anomalies, especially with high imperforate anus (VATER, VACCTERL). Diagnosis of this condition is by careful physical exam of the perineum, forchette, and vestibule. Low imperforate anus will present as a fistula that ends at the posterior forchette in females and at the median raphe of the penis or scrotum in males. Radiographic evaluation includes lateral x-ray with the buttocks up or pelvic x-ray with the infant held upside down. Treatment of high imperforate anus is colostomy with later posterior sagittal anorectoplasty, and for low imperforate anus, treatment may be performed by a perineal approach.

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