Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA.
J Med Case Rep. 2021 Jul 15;15(1):370. doi: 10.1186/s13256-021-02921-3.
This report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40 years after imperforate anus repair.
A 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum.
Although rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.
本报告描述了一例罕见的中年患者在先天性肛门闭锁修复后 40 年出现腹腔内肿块的手术病例。
一名 44 岁的拉丁裔男性，曾患有肛门直肠畸形修复术，因反复尿路感染和直肠脱垂伴出血和粪便失禁而就诊。在术前评估中，根据磁共振成像（MRI）结果，他最初被诊断为前列腺囊囊肿，MRI 显示囊性、厚壁肿块，内容物呈低信号，向下延伸至插入远端前列腺尿道。然而，在手术切除时，厚壁结构内含有陈旧、坚硬的粪块。最终的病理报告描述了符合结肠组织的发现，提示存在原始瘘管和憩室的残留。
尽管罕见，但先天性肛门闭锁修复后持续存在的直肠尿道瘘管和直肠憩室可在数十年后引起症状，需要手术干预。对于任何有先天性肛门闭锁病史的成年患者，这都是一个重要的诊断考虑因素。
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