Anal- skin (perineal) fistula
From a surgical and prognostic point of view, this frequent variant of the deficiency is the equivalent of a skin fistula in boys. With this form, rectal abnormalities are located inside the sphincter mechanism, with the exception of its lower part, which is anteriorly displaced. The rectum and vagina are well separated from each other.
With this serious wadi, the prognosis in terms of bowel function is usually good if surgical treatment is correctly and competently performed. With this wadi, the gut opens directly behind the hymen on the eve of the vagina. Immediately above the fistula of the rectum and vagina are separated only by a thin common wall. In such patients, muscles and sacrum are usually well developed and innervation is not disturbed. However, in some cases, with this form of defect, the sacrum is underdeveloped. It is possible to accurately identify this form of defects on the basis of clinical data with the usual, but very diligent examination of the perineum and genitals of the newborn girl. Many pediatric surgeons successfully correct this flaw without a protective colostomy.
This anomaly is very rare. Since the rectum is connected with the lower or upper part of the vagina with this liquid form of deficiencies, a diagnosis of this form can be made when meconium is released through the hymen in a newborn girl . A defect in the back of the hymen is another sure sign, which confirms the diagnosis. Anorectal agenesis without fistula in girls is much more common than in boys, and in terms of therapeutic tactics and prognosis it absolutely corresponds to the same variant of anomaly in boys.
Persistent cesspool in girls
A complex defect in which the rectum, vagina and urinary tract merge into a single channel. The diagnosis can be confidently made on the basis of clinical data. It can be suspected in cases where the newborn girl with atresia of the anus has very small genitalia. With careful dilution of the labia, a single hole can be seen on the perineum. The length of the common channel varies from 1 to 7 cm and is of great importance in terms of the technique of surgical intervention and relative to the prognosis. If the length of the common channel exceeds 3.5 cm, then this is usually the most difficult variant of the anomaly, in which various methods of plastic surgery of the vagina have to be applied. Sometimes the rectum opens high in the vagina. Quite often, the vagina is excessively stretched and filled with mucous secretion ( hydrocolpos ). An overstretched vagina squeezes the urinary bubble triangle, which often leads to the development of megaloureter . On the other hand, the presence of a large-sized vagina facilitates its plasticity. With cloacal defects, membranes or doubling of the vagina and uterus are quite common, expressed to varying degrees. In a similar situation, the rectum usually opens between two vaginas. With low cloacal defects of the buttocks, they are usually well developed, the perineum looks normal, the muscles are formed correctly and the innervation is not broken. Accordingly , the prognosis is often good.