Delayed repair of an anorectal malformation in a 12-year-old girl using perineal body– sparing technique in a resource-limited setting: A case report

Abstract

Background: Anorectal malformations (ARM) are congenital anomalies that require early surgicalcorrection to achieve optimal functional outcomes. However, in many resource-limited settings, restricted access to specialized care often delays definitive repair, leading to prolonged colostomy dependence and substantial psychosocial consequences. Case: A 12-year-old girl from northwestern Uganda presented for surgical evaluation during a pediatric surgical outreach. In her first week of life, she failed to pass meconium and developed progressive abdominal distension. At one week of age, she underwent a diverting colostomy at a regional referral hospital in northwestern Uganda. Before she turned one-year-old, her mother left her in her grandmother's care, later remarrying. She then lived with a colostomy for 12 years. This led to embarrassment, social withdrawal, and bullying at school, and she ultimately discontinued formal education shortly after enrolling at age five. She was later scheduled for definitive repair and underwent a perineal body–sparing posterior sagittal anorectoplasty (PSARP). During this procedure, the vestibular fistula was identified and closed from within the posterior sagittal incision, preserving the perineal body. At the two-week postoperative visit, the neo-anus was patent, and the wound was healing well. She subsequently underwent scheduled anal dilatations for eight weeks following the PSARP procedure, after which colostomy closure was performed. Her postoperative course was uneventful, and she continues to do well on follow-up. Conclusion: The perineal body–sparing PSARP technique seems to be a safe and effective option for the delayed repair of a rectovestibular fistula.