The simplicity of surgical repair and better functional result make it imperative to distinguish low imperforate anus from high pouch anomalies. Male infants with low imperforate anus frequently present with tiny perineal fistulas in the scrotal raphe. Close inspection under good lighting and careful probing are necessary to uncover these occult fistulas. Reliance should not be placed on inverted Wangensteen-Rice roentgenograms as a diagnostic measure.
McGovern B. Occult Perineal Fistula in Male Infants With Imperforate Anus. Am J Dis Child. 1972;123(1):26-27. doi:10.1001/archpedi.1972.02110070076007