ABSTRACT
This chapter explains that a new born male infant with an anorectal malformation and there is no apparent opening on the perineum and examines the male infant has a very "flat bottom" with only a minimal gluteal fold. It explores that waiting 24 hours to perform a cross table radiograph before proceeding to a colostomy is best to see if there is a fistula. Not all infants with an anorectal malformation require a cross table radiograph. If there is meconium staining the urine, for example, the diagnosis of rectourethral/vesical fistula can already be made and the child would require a divided colostomy. The cross table radiograph should not be used to diagnose the position of a rectourethral fistula; instead, a high-pressure distal loop colostogram is needed. Performing a transverse colostomy or an ileostomy is a poor choice as these tend to prolapse, and the distal segment is hard to clean out.
