ABSTRACT
Anorectal anomalies present with a spectrum of defects; on the "good" side of the spectrum, people see patients with minor malformations that require minimal treatment with excellent results; on the other extreme of the spectrum, they find cases with complex defects, which represent a serious technical challenge and for whom the results in terms of bowel, urinary, and sexual function are not good despite accurate anatomic reconstruction. Patients with this defect have an abnormal communication between the rectum and the perineum, often with a "bucket-handle" malformation. The common anatomic feature is the fact that the intestinal opening is located anterior to the center of the sphincter mechanism, as demonstrated by electrical stimulation during the repair. In cases of prostatic fistula, the chances of having a short sacrum and a flat perineum increase. This is a rare type of defect classically described as the one that is diagnosed by the nurse while passing the thermometer during the initial newborn physical examination.
