Complete VACTERL evaluation is needed in newborns with rectoperineal fistula.
OBJECTIVE
Given that a rectoperineal fistula is developmentally the most mature lesion in the spectrum of anorectal malformations, it is not clear whether it merits a complete VACTERL evaluation. We sought to determine if the same evaluation is required to rule out associated anomalies in newborns with rectoperineal fistula as those with more complex anorectal malformations.


METHODS
We performed a retrospective review of the pediatric colorectal center database at our tertiary care children's hospital from 2000 to 2012. Patients with anorectal malformations were categorized as rectoperineal fistula or "other" using the Krickenbeck classification. Records were reviewed to identify associated anomalies.


RESULTS
308 patients (156 males) were treated at our institution during the time period (rectoperineal fistula=102). Thirty-five (34%) patients with a perineal fistula had at least one associated anomaly. The most common anomalies were cardiac lesions (29% excluding PFO and PDA), genitourinary (20.6%), and malformations of the spine (15.7%). The overall occurrence of anomalies was lower than the "other" group.


CONCLUSIONS
Our review demonstrates that newborns with a rectoperineal fistula frequently have associated anomalies and should undergo an evaluation similar to more complex lesions. These findings illustrate the importance of a structured approach to the evaluation of even the most straightforward lesions.
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA. Electronic address: michael.rollins@imail.org.
Michael D
MD
Rollins
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Katie
K
Russell
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Kathy
K
Schall
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Sarah
S
Zobell
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Ramon F
RF
Castillo
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Lesley
L
Eldridge
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Eric R
ER
Scaife
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Douglas C
DC
Barnhart
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000453:epidemiology; D001003:Anal Canal / Q000002:abnormalities*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications / Q000175:diagnosis; D025063:Chromosome Disorders / Q000453:epidemiology; D017577:Cutaneous Fistula / Q000209:etiology*; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine; D004947:Esophagus / Q000002:abnormalities*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities*; D017880:Limb Deformities, Congenital / Q000175:diagnosis*; D008297:Male; D010502:Perineum / Q000002:abnormalities*; D012003:Rectal Fistula / Q000209:etiology*; D012007:Rectum / Q000002:abnormalities; D012189:Retrospective Studies; D013131:Spine / Q000002:abnormalities*; D063189:Symptom Assessment; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014132:Trachea / Q000002:abnormalities*
Anorectal malformations; Ectopic anus; Perineal fistula; Rectoperineal fistula