perineal(cutaneous) fistula

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Patients with imperforate anus and a perineal, cutaneous fistula have the opening of the latter situated between external genitalia and the site of the external anal sphincter.

Perineal inspection reveals:

  • a 'bucket handle' skin tag
  • a meconium-filled, black subepithelial area representing the fistula
  • an anal dimple

Repair in both sexes involves a minimal posterior sagittal anoplasty at 3-4 months of age. The rectum is partially dissected and then moved to the region of the external sphincter. The formation of a protective colostomy is not required.

Prognosis for return of function is excellent, but intermittent constipation remains a residual problem in most cases. It is treated prophylactically.

Last reviewed 01/2018