Meconium is not enough: look for the hole

Anorectal malformations are usually diagnosed at birth, and the diagnosis is usually readily apparent in boys and girls by direct inspection of the perineal region. However, some of the less complex lesions, often referred to as ‘low lesions’, such as rectovestibular fistula in girls, may not be diagnosed at birth. These children are able to pass meconium, and it is only when the narrow fistula fails to pass formed stool later in infancy or childhood does the child become symptomatic. It is important to emphasise that the diagnosis of these defects should be made during neonatal predischarge examination. Such a delayed diagnosis may change their management, complicate surgical repair and may contribute to both functional and psychological problems for the patient and family.