As a Pediatric Surgeon ,i have seen more than 10 cases in my carrier,As it's a Spectrum of complex anomalies,We operate on them few days after birth colostomy and vsginostomy by a lower midline incision,placind colostomy at the left side and vaginostomy tube right side,Those complex with long common channel were operated abroad by Dr.Pena.Some of them passed the tranzional pediatric period,Looking for help by adult colleague for follow-up but still difficult to find,These children are patient for life.Thanks.

Anorectal malformation is a spectrum of defects,In female we usually start our workup with a Genitalia inspection ,were in normal infant we pull out-up labial and see two orifice urethra,vagina,Perineal body and well located normal anus surround by sphincter, Hegar size 12.If we see a small genitalia with single orifice ,we start our work-up for cloacal anomalies.Plain abdominal x-ray limbo-sacral A-P,Lateral view,Sacrum=Spine anomalies,Abdominal ultrasound associated anomalies for kidney,Pelvia ultrasound to rule out hydrocolpos=hydronephrosis.Spine ultrasound for tethered cord.Ecocardiogram.

At the time of surgery-Vaginoscopy and cystoscopy, to evaluate the length of CC,the urethra and the live of vagina,Decisione-Making for Repair plus 3D-Cloacal gram if available or study through stomas and orifice available.

1-Some case of cloacal repair were the rectum is pulled done and left intact urogenital sinus2- Vaginal fistula very rare finding. 3-Vestibular fistula with absent vagina 4-DSD.

Yes these patients are patients for life.

However when diagnosed at right time, treated and kept in follow up can make their lives so much better.

We see about 10 - 15 new cases ayear. There was a recent patient who underwent PSARP for what eas thougt to be a simple rectovestibular fistula , but turned out to have a cloacal malformation

That's insightful.

Could you share more details without mentioning any patient identifiers.