article · Journal of Rare Diseases
Anorectal malformations encompass a range of congenital conditions affecting the rectum, distal anus, and urogenital systems. A rectouterine fistula is an exceptionally uncommon variant occurring in females, lacking a standardised clinical treatment pathway, especially in low-resource environments. This report outlines the treatment of a seven-day-old female newborn who presented with an imperforate anus and bowel obstruction. Surgical exploration identified a high-type malformation with a connection connecting the uterine body to the rectum, categorized under the Krickenbeck classification as a rare female genital tract fistula. The immediate surgical intervention consisted of a laparotomy, ligation of the fistula, and the establishment of an end colostomy. Following an uneventful initial recovery, a definitive pull-through anorectoplasty was scheduled for nine to twelve months later to allow for necessary physical growth and improved nutrition.
Congenital abnormalities of the anorectal tract can cause critical complications such as intestinal blockages immediately after birth. Because rectouterine fistulas are extremely uncommon, clinical evidence guiding their care is limited. Documenting effective staged surgical interventions provides medical teams, particularly those working in resource-constrained environments, with viable clinical pathways to safely stabilize and treat newborn infants experiencing rare and complex anatomical conditions.
The abstract does not indicate an application pathway, as it reports a single surgical case study rather than a commercial product or technology.
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Abstract Background Anorectal malformations (ARMs) represent a spectrum of congenital anomalies involving the distal anus, rectum, and urogenital tracts. A rectouterine fistula is an extremely rare variant in females, with limited reports and no standardized management approach, particularly in low-resource settings. Case presentation We report a 7-day-old female neonate with imperforate anus and intestinal obstruction. Clinical evaluation and surgical exploration revealed a high-type ARM with a fistulous connection between the rectum and uterine body, classified according to the Krickenbeck system as a rare variant of a fistula to the female genital tract. The initial management involved laparotomy, fistula ligation, and formation of an end colostomy. The postoperative recovery was uneventful. The patient was scheduled for a definitive pull-through anorectoplasty after 9–12 months, once growth and nutritional status improved. Conclusion This case represents one of the few documented examples of congenital rectouterine fistula in the neonatal period. A staged surgical approach remains safe and effective in resource-limited settings. Early diagnosis, multidisciplinary collaboration, and individualized surgical planning are crucial for optimal outcomes.
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DOI: 10.1007/s44162-025-00137-3
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