Rectal Atresia - a Unique Anorectal Malformation

A narrow anal opening could represent anal stenosis or rectal atresia.

In cases of narrow anal opening or rectal atresia, one must screen for curino triad and ensure there is no associated presacral mass.

Associated presacral masses are usually a teratoma or a meningocele.

Rectal atresia should now be treated like Hirschsprung's disease.

If the rectum is high in rectal atresia, laparoscopy can be used to mobilize it.

If the rectum is low in rectal atresia, it can be approached transanally only.

The transanal approach to rectal atresia is very different from the previously described approach, which used a posterior sagittal approach to find the distal rectum.

The surgeon can avoid a posterior sagittal incision and reach the rectum transanally just like in a Swenson technique.

The transanal dissection involves incision 0.5 centimeters proximal to the dentate line.

The mobilized distal rectum is anastomosed to the anal canal, just like in a case for Hirschsprung's disease.

The dissection proceeds looking for the typical whitish fascia that surrounds the rectum, just like for all PARPs, for a Swenson plane mobilization of the rectum.

On the anterior side of the dissection, one must be careful not to hurt the urethra by staying right against the rectal wall.

The very distal rectum is trimmed off where the fibrotic tissue of the atresia was.

Full thickness bites are taken from the rectal lumen to the anal canal for the anastomosis.

Sutures placed at 12, 3, 6, and 9 o'clock help take care of any size discrepancy between the two circles being connected to each other.