“Hidden” Fistula in a Newborn with Imperforate Anus

An 18-hour male newborn was sent to our institution for evaluation of imperforate anus and “no visible fistula” and colostomy creation. Physical exam showed no cardio respiratory or neurological compromise. He had imperforate anus, descended testicles, normal penis and perineum with a rather normal raphe with no visible fistula or opening (Figure 1). After a more thorough examination of the perineum a fistulous tract extending from the anal dimple to the scrotum became very conspicuous when careful positive pressure was applied to the baby’s abdomen. This made evident the passage of meconium from the rectum into the fistula extending to the scrotum (Figure 2). Afterwards the decision was made to treat the baby with an anoplasty without the need for opening a colostomy. The patient had an uneventful postoperative course and was discharged 7 days later.