Jiménez BB, Hernández CRC, Alegre TE, Velázquez SMP

Language: Spanish
References: 10
Page: 58-62
PDF size: 158.90 Kb.

ABSTRACT

Objective: To describe a case of perineal ectopic anus (cutaneous fistula) in the adult and its surgical treatment.
Design: Case description.
Setting: Third level health care hospital.
Case description: Female patient, 48 eight years old, with anorectal malformation and a history of total anal incontinence since childhood, coursing the last eight months with recurrent vaginal infections refractory to treatment. We found lack of perineal body, rectal opening (fistula) behind the vaginal fourchette, flat anal pit posterior to the fistula and inadequate muscular contraction to cutaneous perineal stimulation. Lack of tone and contraction of the anal sphincter. Studies consisted of endoanal ultrasound, MRI of the pelvic floor, neurophysiological assessments (electromyography of the anal sphincter, motor latency of pudendum nerves), and proctogram. Anorectal malformation, classified as Perineal Ectopic Anus (cutaneous fistula) was diagnosed. Treatment consisted in surgical correction of the congenital anomaly through an anorectoplasty (rectal reimplantation), achieving anatomical correction of the defect and anal continence.
Conclusions: Anorectal malformations in the adult are rare. This case reports reveals the possibility of finding anorectal anomalies in adult women as the cause of anal incontinence and recurrent vaginal infections. It is necessary to choose the adequate surgical treatment.

REFERENCES

1. Shaul DB, Harrison EA. Classification of anorectal malformations-initial approach, diagnostic tests, and colostomy. Semin Pediatr Surg 1997; 6: 187-195.

2. Hassink EA, Rieu PN, Hamel BC, Severijnen RS, vd Staak FH, Festen C. Additional congenital defects in anorectal malformations. Eur J Pediatr 1996; 155: 477-482.

3. Levitt MA, Peña A. Outcomes from correction of anorrectal malformations. Curr Opin Pediatr 2005; 17: 394-401.

4. Corman ML. Colon and Rectal Surgery. 4th Edition. Lippincott-Raven; 1998. p. 449-488.

5. Dillon PW, Cilley R. Newborn surgical emergencies. Gastrointestinal anomalies, abdominal wall defects. Pediatr Clin North Am 1993; 40: 1289-314.

6. Wakhlu A, Pandey A, Prasad A, Kureel SN, Tandon RK, Wakhlu AK. Anterior sagittal anorectoplasty for anorectal malformations and perineal trauma in the female child. J Pediatr Surg 1996; 31(9): 1236-40.

7. Mann CV, Glass R. Surgical treatment of anal incontinence. 2a Ed. Springer-Verlag London; 1997. p. 127-146.

8. Simmang CL, Paquette E, Tapper D, Holland R. Posterior sagittal anorectoplasty: primary repair of a rectovaginal fistula in an adult: report of a case. Dis Colon Rectum 1997; 40(9): 1119-1123.

9. Simmang CL, Huber PJ Jr., Guzzetta P, Crokett J, Martínez R. Posterior sagittal anorectoplasty in adults: secondary repair for persistent incontinence in patients with anorectal malformations. Dis Colon Rectum 1999; 42(8): 1022-1027.

10. Kumar V, Chattopdhay A, Vepakomma D, Shenoy D, Bhat P. Anovestibular fistula in adults: a rare presentation. Int Surg 2005; 90(1): 27-29.