Anorectal malformation into adulthood

Abstract

Anorectal malformations (ARM) encompass a range of defects in the development of the lower portion of the intestinal and urogenital tracts. These malformations are typically diagnosed in the neonatal period; however, they can, on rare occasions, present in adulthood if the condition has been neglected and left untreated since birth. This report details a case involving a 22-year-old woman who presented with intestinal obstruction due to an absent anus, a condition she had had since birth. At the time of her presentation, she was diagnosed with ARM with a rectovestibular fistula. Further evaluation revealed no associated congenital anomalies that would suggest a congenital syndrome. To correct the anomaly, she underwent a three-stage surgical procedure: an emergency laparotomy with diverting sigmoid colostomy at the initial presentation, followed by posterior sagittal anorectoplasty (PSARP) six months after the diverting colostomy, and a reversal of the colostomy two months following the PSARP. As a result of these interventions, she now has satisfactory anal function and good continence.