Adult Presentation of Anorectal Malformation: A 19-Year-Old Woman with a Delayed Diagnosis of Recto-Vestibular Fistula.

BACKGROUND In developing countries, the diagnosis of anorectal malformations (ARM) is often made late, with patients presenting in their teenage years or beyond. This has been attributed to several factors, including ignorance, poverty, and weak social support systems. We report a rare case of adult ARM and the problems encountered in her surgical management. CASE REPORT A 19-year-old woman presented with symptoms of chronic constipation. During further clinical evaluation, she was diagnosed with ARM with a recto-vestibular fistula. Her preoperative work-up to rule out other associated anomalies included an ECHO, KUB ultrasound, and pelvic MRI. She underwent a 3-stage repair, with the initial stage being a diverting colostomy and then definitive surgery after 6 months. We closed her stoma 3 months after the definitive surgery. In the immediate postoperative period, she developed wound dehiscence that was managed conservatively. Later, she had incontinence of stool and flatus. With the support of a multidisciplinary team, she was placed on a bowel management program and guided through pelvic floor exercises. About 5 weeks later, she was discharged home to continue follow-up at the surgical outpatient clinic. CONCLUSIONS The case report offers lessons to surgeons on the management of ARM with delayed presentation. It describes intraoperative challenges, potential postoperative complications, and possible solutions while highlighting follow-up difficulties in low- and middle-income countries (LMICs) due to inadequate social support. We also stress the need to improve healthcare systems to facilitate early ARM diagnosis.