Pediatr Surg Int (1997) 12:283-285 © Springer-Verlag 1997

A. W a k h l u • A. P a n d e y • A. P r a s a d • S. N. K u r e e l
R. K. T a n d o n • A. K. W a k h l u

Perineal canal

Accepted: 9 May 1996

Abstract Perineal canal (PC) is a rare anomaly constitut-
ing 4% of all anorectal malformations. Sixty patients (56
females and 4 males) with PC managed over the past
27 years are reported. The ages ranged from 2 days to
13 years. The chief symptom was passage of fecal matter
through both the anus and the fistula. One girl had under-
gone previous, unsuccessful surgery. All our patients were
treated by anterior sagittal anorectoplasty (ASARP), which
allowed anatomic exposure and accurate repair of the
anomaly. In 49 patients without any perineal inflammation
primary A S A R P was undertaken. Surgery was delayed in
11 patients with perineal excoriations and/or active inflam-
mation. One patient died post-operatively due to unrelated
causes and 1 developed a recurrence. Anal dilation was
required in 7 cases. Fifty patients were seen at first follow-
up 12 weeks after surgery. All were continent and had
normal defecation without the use of laxatives. Thirty-four
could be followed up to the age of 3 years; they were
continent with normal bowel habits. There was no shift in
the position of the anus and no instance of rectal dilation.
Individualization of the management and operation by the
anterior sagittal approach thus offers good results in this
uncommon anorectal anomaly.
which there is a fistula between the anterior wall of a
normally-formed anus/rectum and the vestibule/perineum
in females or the perineum/anterior urethra in males. Since
the initial reports by Bryndorf and Madsen [1] and Pegum
et al. [7], patients with PC have been reported mostly from
Asian countries [3]. Although the diagnosis is straightfor-
ward, the conventional treatment of this anomaly leaves
much to be desired. The present paper details our experi-
ence with the management of PC over the past 25 years. We
also describe a surgical technique that has given consis-
tently good results.
Materials and methods
Of 1600 patients with ARM treated at our hospital between 1969 and
1995, there were 60 with PC (3.8%), who constituted 7.3% (56/776) of
females with ARM (Table 1).
In female patients the chief symptom was defecation through both
the anus and the fistula (Table 2). The parents of one 6-year-old girl
attributed the malformation to a sexual assault. In another girl with
Table 1 Age and sex distribution of the patients

Age Males Females

Key words Anorectal malformations • Perineal canal •
Anterior sagittal anorectoplasty Neonate 2 4
Infant 1 37
Child 1 15
Total 4 56
introduction
Table 2 Presenting features
The term "perineal canal" (PC) was coined by Stephens and
Smith [10] in 1971 for an anorectal malformation (ARM) in Symptoms No. of patients
Passage of feces through both anus and fistula 48
Passage of feces through fistula only due to 12
A. Wakhlu • A. Pandey • A. Prasad • S. N. Kureel • R. K. Tandon • severe anal spasm
A. K. Wakhlu
Division of Pediatric Surgery, Department of Surgery, King George's Perineal excoriation 7
Medical College, Lucknow, Uttar Pradesh, India
Perineal abscesses 4
A. K. Wakhlu ( ~ )
B 1-99 Sector 'G', Aliganj, Lucknow 226020, UR India Persistent vaginal discharge 1