THE CONGENITAL malformation wherein a normal anus is separated from a blind rectal pouch is classified by Ladd and Gross1 as type 4 (fig. 1). It constitutes a small percentage of anorectal anomalies but is reported to bear a high mortality. The following discussion, which concerns only the type 4 anomaly without urogenital fistula, raises the question whether a discarded surgical procedure, transabdominal repair of the defect, may be performed without increased hazard and with satisfactory result.
With the risk of deemphasis of the fundamental problem of the structural fault in cases of this malformation, brief mention will be given of the embryologic developments involved (fig. 2). As the cloaca is divided into separate urogenital and intestinal systems at about the seventh week by the urorectal septum, the perineum is formed. The proctodeum develops from the ectoderm, and an external opening is formed by rupture of the anal membrane
PATTON RJ. CONGENITAL ANORECTAL ATRESIAReport of a Case. Arch Surg. 1949;58(6):907-912. doi:10.1001/archsurg.1949.01240030918016