Delayed presentation of anorectal malformation with rectourethral fistula in an infant: a case report.

Introduction and importance: Anorectal malformations (ARMs) are common congenital anomalies, often associated with rectourethral fistulas in male infants. Early diagnosis and staged surgical management are essential to prevent complications. However, delayed presentation remains common in low-resource settings and contributes to avoidable morbidity. Case presentation: We report a 56-day-old male infant presenting with progressive abdominal distension and the passage of stool through the urethra since early neonatal life. He was delivered at home, and care was delayed due to a lack of awareness. Examination revealed the absence of an anal opening with stool at the urethral meatus, consistent with a high ARM. A diverting colostomy was performed initially. Definitive posterior sagittal anorectoplasty was later carried out based on clinical findings, as distal colostography was unavailable. Colostomy closure followed three months later. At a 9-month follow-up, the child showed good bowel continence without constipation or urinary symptoms. Clinical discussion: ARMs with rectourethral fistula require early recognition and staged repair to prevent complications such as obstruction, urinary tract infections, and poor bowel outcomes. In low-resource settings, delayed presentation is frequent, and access to imaging, like distal colostography, is limited. Careful clinical evaluation can still allow accurate diagnosis and safe surgical management. This case demonstrates that good functional outcomes are achievable without advanced imaging when guided by sound clinical judgment. Conclusion: Delayed presentation and limited diagnostics remain major challenges. Nevertheless, careful assessment and staged surgery can result in favorable outcomes even without advanced imaging.