International journal of surgery case reports · 2026
H-type anorectovaginal fistula with anterior ectopic anus in a 15-month-old girl: a case report.
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Sed Zubair Mohamed Dahir, Warsame Badrudin A
Аннотация
INTRODUCTION AND IMPORTANCE: H-type anorectovaginal fistula is a rare anorectal malformation characterized by an abnormal communication between the rectum and vagina despite a normally formed or near-normal anus. Diagnosis may be delayed due to the absence of obvious external anatomical abnormalities, making clinical recognition essential, particularly in resource-limited settings.
CASE PRESENTATION: We report a 15-month-old girl presenting with fecal vaginal discharge and chronic constipation since early infancy. Clinical examination revealed an anterior ectopic stenotic anus with vaginal fecal contamination, consistent with H-type anorectovaginal fistula. Diagnosis was established clinically due to clear findings and financial constraints limiting access to advanced imaging modalities. Abdominal radiography demonstrated a loaded rectosigmoid colon, while abdominal ultrasonography was normal. The patient underwent limited posterior sagittal anorectoplasty with fistula division and reconstruction. The postoperative course was uneventful, and bowel management was initiated early. At 2-year follow-up, the patient demonstrated age-appropriate continence based on clinical assessment and parental reporting consistent with expected developmental stage, with no recurrence or complications.
CLINICAL DISCUSSION: H-type anorectovaginal fistula is an uncommon variant of anorectal malformations and may present diagnostic challenges due to subtle external findings. Management remains controversial because of anatomical variability; however, posterior sagittal anorectoplasty provides direct access for precise anatomical correction. In selected patients, single-stage repair without diversion can achieve favorable outcomes when conditions are optimal.
CONCLUSION: Careful clinical evaluation remains the cornerstone of diagnosis in rare anorectal malformations. Individualized surgical management based on anatomy and reconstructive principles can achieve good functional outcomes even in resource-limited environments.
CASE PRESENTATION: We report a 15-month-old girl presenting with fecal vaginal discharge and chronic constipation since early infancy. Clinical examination revealed an anterior ectopic stenotic anus with vaginal fecal contamination, consistent with H-type anorectovaginal fistula. Diagnosis was established clinically due to clear findings and financial constraints limiting access to advanced imaging modalities. Abdominal radiography demonstrated a loaded rectosigmoid colon, while abdominal ultrasonography was normal. The patient underwent limited posterior sagittal anorectoplasty with fistula division and reconstruction. The postoperative course was uneventful, and bowel management was initiated early. At 2-year follow-up, the patient demonstrated age-appropriate continence based on clinical assessment and parental reporting consistent with expected developmental stage, with no recurrence or complications.
CLINICAL DISCUSSION: H-type anorectovaginal fistula is an uncommon variant of anorectal malformations and may present diagnostic challenges due to subtle external findings. Management remains controversial because of anatomical variability; however, posterior sagittal anorectoplasty provides direct access for precise anatomical correction. In selected patients, single-stage repair without diversion can achieve favorable outcomes when conditions are optimal.
CONCLUSION: Careful clinical evaluation remains the cornerstone of diagnosis in rare anorectal malformations. Individualized surgical management based on anatomy and reconstructive principles can achieve good functional outcomes even in resource-limited environments.