Imperforate anus—some form of developmental defect of the anorectal bowel, varying from simple stenosis of the anus to absence of anus and rectum— occurs once in every 6,000 to 10,000 births. The types of malformations have been classified into four categories by Ladd.1 When the additional developmental anomaly of rectourethral of rectovesical fistula in conjunction with the imperforate anus occurs, "in the male, the fistulous termination of the rectum in the bladder or urethra unless relieved is followed by early death from pyelonephritis."2 After a thorough survey of the literature and personal communications with American surgeons,3 I believe the present case to be the only one in which a man with a Ladd type 3 imperforation and rectourethral fistula has survived without definitive surgical therapy until the age of 27 years. The end result of the surgical treatment is considered satisfactory scientifically—to the patient, excellent.
Duffy JJ. IMPERFORATE ANUS AND RECTOURETHRAL FISTULA IN A TWENTY-SEVEN YEAR OLD MAN: REPORT OF A CASE. JAMA. 1951;145(8):545–548. doi:10.1001/jama.1951.02920260013003
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