Pediatr Surg Int (1994) 9:603-604
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 b y excising the
canal and letting it to granulate from
the bottom up. We believe 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 o f 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].
© Springer-Verlag 1994
Anatomically, 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-
tirely 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 m a y 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 vestibulum 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 barium 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 definitive repair [3].
In low-lying cases, excision of the tract
with the anterior wall of the rectum
below the fistula has been re-
c o m m e n d e d [6]. We believe this tech-
nique is unnecessarily extensive con-
sidering the simplicity of the anomaly.
There is also a good chance of infec-
tion and wound breakdown with the