Transposition of the Anus

Abstract

The case which is herewith reported was that of a girl, aged 4½, who was first seen in September, 1939 with a chief complaint of congenital absence of the rectal opening in the perineum; however, she had an opening into the vagina (Fig. 1) which in appearance was not unlike a normal anus. The only repair had been a slight enlargement of the opening into the vagina to permit freer bowel movements.

The patient had an almost constant fecal drainage unless she was constipated; then she had formed stools. There was no history of bladder difficulty nor nocturia, although there had been some frequency; and the child had good bladder control. Some voluntary control of bowel movements also had been observed.

In June, 1941 the patient was admitted to the Cleveland Clinic Hospital for operation. Under general anesthesia a loop sigmoid colostomy was performed, after which the lower bowel was thoroughly cleansed. When the colostomy was functioning well, an opening was made in the perineum, and the opening in the vagina dissected free (Figs. 2 and 3). With a long forceps this part of the gut was transposed to the new opening in the perineum (Fig. 4). The transposed opening was then sutured to the skin and perineal tissue. A perineorrhaphy was performed which obliterated the newly made opening in the vagina (Fig. 5). The child's mother was instructed in the dilatation of the anus every other day, and the child was sent home to return later for closure of. . .