Answer:

A newborn without an anus, passing stool through the vagina, has a birth defect known as anorectal malformation (ARM), specifically a recto-vaginal fistula or an ano-vaginal fistula. Infants with this condition may have a fistula connecting the rectum or anus to other areas, such as the perineum, urinary tract, or genitals. This occurs when the anus and rectum do not form properly during fetal development.

This can be caused by genetic factors or VACTERL association, a condition involving multiple birth defects affecting the vertebrae, anus, heart, trachea, esophagus, kidneys, and limbs.

Anorectal malformation requires surgical treatment, depending on the severity and specific type of defect. Based on your description, your baby likely has a recto-vaginal fistula, meaning the rectum connects to the vagina instead of opening at the anus. If her bowel movements pass easily through the vagina, she has no abdominal distension, and is feeding well, an immediate temporary colostomy may not be necessary. Imaging studies, such as X-rays and ultrasounds, can be performed to measure the distance between the rectum and the skin where the anus should be. However, a temporary colostomy is often still required to protect the baby's health and prevent infection.

When your baby is between 3 and 6 months old, surgeons can perform a posterior sagittal anorectoplasty (PSARP) to create a new anus in the correct location and close the abnormal connection to the vagina. After surgery, regular anal dilation with dilators will be necessary to prevent narrowing of the newly formed anus. Follow-up appointments will be scheduled. Once the new anus is functioning properly, the temporary colostomy will be closed, restoring normal bowel function.

If your baby experiences significant abdominal distension, inability to pass stool, or vomiting, seek immediate medical attention. A doctor will conduct a physical examination, provide consultation, and develop a specific surgical plan.

Doctor Trong (far left) operates on a patient with anorectal malformation. Photo courtesy of Tam Anh General Hospital

Doctor Trong (far left) operates on a patient with anorectal malformation. Photo courtesy of Tam Anh General Hospital

Expectant mothers should have regular prenatal checkups and screenings to detect birth defects early. Early detection and timely treatment can help reduce complications and improve the child's quality of life.

Dr. Nguyen Do Trong MD.

Department of Pediatric Surgery

Tam Anh General Hospital, TP HCM