Question:
A newborn male is noted at birth to have an absent anal opening. A diverting colostomy is performed, and a distal colostogram is shown. What is the most likely diagnosis?
A newborn male is noted at birth to have an absent anal opening. A diverting colostomy is performed, and a distal colostogram is shown. What is the most likely diagnosis?
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In males with imperforate anus, the presence of meconium in the urine confirms a recto-urinary fistula.
A distal colostogram is the gold standard investigation performed before the definitive Pull-Through procedure (PSARP) to map the exact fistula anatomy.
A distal colostogram is the gold standard investigation performed before the definitive Pull-Through procedure (PSARP) to map the exact fistula anatomy.
Updated On: Sep 3, 2026
- Rectovesical fistula
- Rectobulbar urethral fistula
- Perineal fistula
- Rectoperineal fistula
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The Correct Option is B
Solution and Explanation
Concept:
The patient is a male newborn with an Anorectal Malformation (ARM), specifically an imperforate anus.
In males, the blind-ending rectum frequently communicates with the urinary tract via a fistula, and the exact level of this fistula dictates the surgical approach (PSARP).
Explanation:
• When an imperforate anus is diagnosed and primary repair is not feasible, a diverting colostomy is performed. Later, a distal colostogram is obtained by injecting contrast into the distal stoma to define the exact anatomy of the rectum and any fistulas.
• In male infants, the rectum most commonly forms a fistula with the urethra.
• If the contrast outlines a fistula entering the higher urinary tract (the bladder), it is a rectovesical fistula (usually indicating a very high, complex defect).
• If the contrast outlines a fistula entering the urethra at the level of the bulbar region, it is a rectobulbar urethral fistula.
• The image provided (as referenced by the question key) shows the distal rectum tapering and communicating directly with the bulbar portion of the urethra, which is a classic intermediate-level anomaly.
• Perineal fistulas usually open directly onto the skin of the perineum and do not require a colostogram for diagnosis (they are visible externally).
• Based on the anatomical level shown in the standard imaging for this specific question, rectobulbar is the correct identification.
Final Answer:
The distal colostogram demonstrates the rectum ending in a communication with the bulbar urethra, diagnosing a Rectobulbar urethral fistula.
The patient is a male newborn with an Anorectal Malformation (ARM), specifically an imperforate anus.
In males, the blind-ending rectum frequently communicates with the urinary tract via a fistula, and the exact level of this fistula dictates the surgical approach (PSARP).
Explanation:
• When an imperforate anus is diagnosed and primary repair is not feasible, a diverting colostomy is performed. Later, a distal colostogram is obtained by injecting contrast into the distal stoma to define the exact anatomy of the rectum and any fistulas.
• In male infants, the rectum most commonly forms a fistula with the urethra.
• If the contrast outlines a fistula entering the higher urinary tract (the bladder), it is a rectovesical fistula (usually indicating a very high, complex defect).
• If the contrast outlines a fistula entering the urethra at the level of the bulbar region, it is a rectobulbar urethral fistula.
• The image provided (as referenced by the question key) shows the distal rectum tapering and communicating directly with the bulbar portion of the urethra, which is a classic intermediate-level anomaly.
• Perineal fistulas usually open directly onto the skin of the perineum and do not require a colostogram for diagnosis (they are visible externally).
• Based on the anatomical level shown in the standard imaging for this specific question, rectobulbar is the correct identification.
Final Answer:
The distal colostogram demonstrates the rectum ending in a communication with the bulbar urethra, diagnosing a Rectobulbar urethral fistula.
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