Modified Primary PSARP for an Adult Patient With Imperforate Anus With Rectoperineal Fistula in a Low-Resource Setting: Case Report.

Anorectal malformations (ARMs) are congenital anomalies that include a variety of anomalies. An imperforate anus is the most typical presentation of all the ARMs. It can present with a fistula of the vestibule, vagina, fourchette, and perineum. Though in developed countries, it is diagnosed early and managed during the first few months of life, in low-resource settings, patients present with ARM later in life. Our case presented a 24-year-old with an imperforate anus and rectoperineal fistula. This is the oldest patient to be reported in the literature with an imperforate anus. Modified posterior sagittal anorectoplasty was done. The technique employed is perineum-preserving anal transposition. The procedure was successful. During 6 months of follow-up, the reconstruction appeared smooth; she could control flatus and stool. She can differentiate between gas and stool. No constipation and no soiling. In low-resource settings, patients present late during adulthood. Modified (perineum-sparing) posterior sagittal anorectoplasty with anal transposition is an appropriate option for adult patients with ARMs.