Pediatr Surg Int (1994) 9:603-604 © Springer-Verlag 1994

Perineal canal: a simple method of repair

Adel Ismail

Hamad Medical Corporation, P. O. Box 3050, Doha, State of Qatar

Accepted 1 December 1993

Abstract. A perineal canal is a rare congenital , external cloacal anomaly. It is either low or high. We treated a girl with a low anomaly by excising the canal and letting it to granulate from the bot tom up. We bel ieve that this method is simple and that recurrence of this anomaly is avoided.

Key word: Perineal canal

Introduction

Perineal canal is a rare congenital anomaly of the external cloaca. It can be classified as high or low, depending on the site of the canal opening in the anorectum in relation to the levator ani [3]. We present a simple method of repair for the low-lying type of this anomaly in females.

Case report

A 5-month-old girl presented with fecal soil- ing through her vagina. On examination, she had a normal anus and vulva. There was a fistula between the anal canal a few milli- meters from the anal verge and the vestibule of the vagina. The anus was not stenotic. She had no other congenital anomalies.

In a previous experience with this anom- aly, when excision and primary repair of the perineum was done, wound infection, break- down, and formation of an anal fistula anterior to the anus resulted. We decided to apply a

Correspondence to: A. Ismail

Fig. 1. Probe inserted through fistula

different technique in this case. A probe was passed through the fistula (Fig. 1), which was laid open. The fistular tract was excised from the anal canal to the vestibule. The external sphincter was incised from the opening of the fistula down. The wound was packed with sofia tule. Histopathology showed a squa- mous-cell lining and no evidence of muscle tissue around the tract.

After every defecation the wound was cleaned with savlon and packed to prevent premature healing. A month after the opera- tion the wound had healed completely, leaving a neat scar along the perineum. The child was continent from the 1st postoperative day. She passed stools with equal frequency as before the operation and she was clean between defecations. Due to family, we were not able to obtain a photograph of the perineum after complete healing.

Discussion

Perineal canal is a rare anomaly of the external cloaca that was first described by Bryndoff and Madsen in 1960 [2].

Anatomical ly, it can be divided into two types, one with the tract originat- ing above the levator ani to the vesti- bule and the second with the tract en- t irely below the levator ani [3]. In fe- males the canal lies entirely in the perineum, while in males the ure- throanal fistula traverses the pelvis. The anus may be normal or stenotic [5].

The narrow part of the cloaca be- tween the anorectal and urogenital di- visions is called the cloacal duct. The perineal groove, which has been de- scribed as a wet and red sulcus from the anus to the vest ibulum in some females, is probably a relic of the open cloacal duct [7]. The perineal canal is congenital in origin and results from bridging over of the perineal groove by the genital folds over a rudimentary perineal mound, leaving a tract be- tween vestibule and anus [1, 5]. The course of the tract can be defined by examination with the help of a probe, together with a bar ium study using the technique described by Tsuchida et al. [61.

The treatment depends on the type of canal. For tracts originating above the pelvic floor, fashioning of a de- functioning colostomy has been de- scribed before the definit ive repair [3]. In low-lying cases, excision of the tract with the anterior wall of the rectum below the fistula has been re- commended [6]. We bel ieve this tech- nique is unnecessari ly extensive con- sidering the simplici ty of the anomaly. There is also a good chance of infec- tion and wound breakdown with the