Perineal Fistula
Rectorurethral Prostatic Fistula
Perineal Subepithelial Fistula
Bucket Handle Malformation
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The common denominator in this type of defect is the fact that the rectum opens into the perineum anterior to the center of the external sphincter. Most of the rectum is passing through the funnel-like muscle mechanism. It is intimately attached to the posterior urethra, and only the most distal part of the rectum is anteriorly deviated.
The perineal fistula usually causes obstruction because it is very narrow. Many times, the rectum does not open directly into the perineum but rather follows a subepithelial fistula tract in the midline raphe, opening somewhere at the base of the scrotum, the scrotum itself, or even at the base of the penis.
Therefore, a "black ribbon" type of structure located in the midline raphe should alert the surgeon to the presence of one of these defects.
Other forms of low defects may be seen. The so-called bucket handle malformation is represented by a characteristic perineal deformity at the anal site.
There is a prominent midline skin tag below which a fine instrument can be passed. This represents evidence that there is a low defect and no other studies are required to make the diagnosis.
The operation used to repair these types of defects is called Minimal Posterior Sagittal Anoplasty.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
