Perineal Fistula
Everything in the library about perineal fistula — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Diagnosis & Workup
1 item
Colorectal Quiz Episode 13: Newborn ARM Part 2
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Surgeons, neonatologists, pediatricians, and anyone who cares for the newborn child needs to understand how to evaluate anorectal malformations. To clear things up, Dr. Marc Levitt and Dr. Jason Frischer explain how to make sense of various
podcast15:48 · Jun 2021
Surgical Management
6 items
Surgical Management Of Female Anorectal Malformation Patients Including...
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This video focuses on treatment of the female infant, focusing on the reconstructive aspect of the genitourinary tract and Cloaca. Featuring panel discussions and case presentations by Dr. Marc Levitt.
video57:59 · Nov 2018
Anorectal Malformation Management of Female Patients Part I: Pediatric...
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Drs Marc Levitt, Rama Jayanthi, Carlo Di Lorenzo, and Karen Diefenbach host a half day symposium highlighting new concepts and controversies in pediatric colorectal anomalies, primarily focusing on anorectal malformations.
video26:39 · Jan 2019
ARMs in Female Patients: Pediatric Colorectal Controversies 2014
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Dr. Marc Levitt from Nationwide Children's Hospital presents on the evaluation and surgical management of anorectal malformations, including cloaca, in female patients.
video55:00 · Jan 2019
Colorectal Quiz Episode 29: Female ARM-Post Op Management
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Join Dr. Kathy van Leeuwen and Dr. Cristine Velazco at Phoenix Children’s as they discuss the nuances of post-operative anorectal malformation management following the PSARP procedure with Dr. Marc Levitt and Dr. Jason FrischerHosted by Ama
podcast25:09 · Mar 2022
Colorectal Quiz Episode 29: Female ARM
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Join Dr. Kathy van Leeuwen and Dr. Cristine Velazco at Phoenix Childrenâs as they discuss the nuances of post-operative anorectal malformation management follow
podcast25:08 · Jul 2026
Colorectal Quiz Episode 29: Female ARM
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Join Dr. Kathy van Leeuwen and Dr. Cristine Velazco at Phoenix Childrenâs as they discuss the nuances of post-operative anorectal malformation management follow
podcast25:08 · Jul 2026
Complications
5 items
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky Edited by Nicholas Bruns, MD and Ian C. Glenn, MD In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast48:09 · Jan 2019
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky
Edited by Nicholas Bruns, MD and Ian C. Glenn, MD
In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast48:09 · Dec 2020
Anorectal Malformations Complications
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In this episode, Dr. Marc Levitt from Nationwide Childrenâs Hospital discusses complications of anorectal malformations. This episode is brought to you by the C
podcast48:08 · Jul 2026
Anorectal Malformations Complications
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In this episode, Dr. Marc Levitt from Nationwide Childrenâs Hospital discusses complications of anorectal malformations. This episode is brought to you by the C
podcast48:08 · Jul 2026
Anorectal Malformations Complications
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Anorectal Malformations Complications | Podcast Episode on RSS.com Sign up free Features Resources Pricing Podcasts Sign up free Sign In Stay Current in Pediatric Surgery... Anorectal Malformations Complicat... Anorectal Malformations Compl
podcast48:08 · Jul 2026
Case-Based Learning
2 items
Pediatric Colorectal Contraversies Part I: Pediatric Colorectal Contraversies...
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Directors Drs Marc Levitt and Alberto Pena, and Todd Ponsky,along with faculty including Drs Atsuyuki Yamataka, Paola Midrio, Long Li, Uvi deBlaauw, Sabine Sarnacki, Nguyen Thanh Liem, Luis de la Torre, and Marcela Bailez,discuss pediatric
video25:43 · Sep 2018
Colorectal Quiz Episode 28: Female ARM Management - Perineal Fistula
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Join Dr. Kathy van Leeuwen and Dr. Christine Velazco at Phoenix Children’s as they discuss a specific case of a perineal fistula that leads to further discussion with Dr. Marc Levitt and Dr. Jason Frischer on the different potential finding
podcast19:59 · Feb 2022
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Complications of Anorectal Malformations with Dr. Marc Levitt
Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period.
clinicalMarc Levitt2:57 ↗
Male babies with perineal fistula may pass meconium and no one notices anything wrong with their anorectal anatomy, typically presenting in the first year of life with severe constipation.
clinicalMarc Levitt3:06 ↗
A newborn anus should accept a size 12 Hagar dilator and a 1-year-old should accept a size 15.
clinicalMarc Levitt6:13 ↗
Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation; patients will inherently have some constipation requiring aggressive treatment.
clinicalMarc Levitt4:54 ↗
If a perineal fistula is not centered in the sphincter, patients with loose stool will soil, and athletic activity will cause soiling because sphincter squeeze cannot completely close the hole.
clinicalMarc Levitt5:38 ↗
In females, diagnostic criteria for perineal fistula are: hole too close to vagina (inadequate perineal body), inadequate hole size by Hagar dilators, and hole not centered in sphincter.
clinicalMarc Levitt8:02 ↗
If a female's anal opening is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, no surgery is needed; the perineal body will lengthen with growth.
clinicalMarc Levitt8:47 ↗
The standard practice of checking temperature on forehead or ear rather than rectally makes it easier to miss anorectal malformations in newborns.
opinionMarc Levitt4:25 ↗
An anesthesia nerve stimulator costing $150 with appropriate needle probes works as well as commercial $15,000 stimulators for identifying sphincter muscles.
clinicalMarc Levitt11:06 ↗
The most common colostomy error is opening too distal in the sigmoid, restricting the ultimate pull-through by the location of the colostomy or mucous fistula.
clinicalMarc Levitt17:18 ↗
Incompletely diverting loop colostomies allow stool to spill across and contaminate the distal segment, leading to urinary tract infections.
clinicalMarc Levitt17:45 ↗
With transverse colostomy and large rectourethral fistula, the left colon absorbs urine which doesn't exit the mucous fistula, potentially causing acidosis from urine absorption.
clinicalMarc Levitt18:38 ↗
Prolapse risk depends on colostomy location: mid-transverse allows bilateral prolapse, hepatic flexure allows only distal prolapse, proximal sigmoid allows only distal prolapse because left colon is fixed to retroperitoneum.
clinicalMarc Levitt19:58 ↗
Marking the sphincter ellipse on skin surface before making any incision prevents confusion from muscle stimulation after dissection is open, avoiding misplaced anoplasty.
clinicalMarc Levitt21:30 ↗
A distal colostogram showing flattening of the rectum corresponding to the pubococcygeal line indicates insufficient contrast or pressure; more pressure is needed to overcome the sphincters and reveal the true rectal position and fistula.
clinicalMarc Levitt24:26 ↗
Fistula level is determined by viewing the urethra as a reverse C or elbow: fistula at or below the elbow is bulbar, above the elbow is prostatic, at bladder neck is bladder neck fistula.
clinicalMarc Levitt25:23 ↗
Bulbous rectum on colostogram may be reachable posterior sagittally and difficult laparoscopically; tapered rectum is better approached laparoscopically.
clinicalMarc Levitt25:55 ↗
Opening posterior sagittally without knowing exact rectal location risks finding and potentially mobilizing bladder neck instead of rectum.
clinicalMarc Levitt27:00 ↗
Bulbar and low prostatic fistulas with bulbous rectum are best approached posterior sagittally; high prostatic with tapered rectum and bladder neck fistulas are best approached laparoscopically.
clinicalMarc Levitt30:09 ↗
Attempting laparoscopy for bulging rectum below peritoneal reflection at low prostatic or bulbar level risks leaving behind a remnant of the original fistula (roof) if the surgeon is timid.
clinicalMarc Levitt30:43 ↗
Laparoscopy replaces laparotomy, not PSARP; a mini-PSARP during laparoscopy allows safe entry through peritoneal reflection and tacking rectum to posterior muscle complex to prevent prolapse.
opinionMarc Levitt31:48 ↗
Rectal prolapse occurs in about 3% of cases, particularly in patients without great muscles.
epidemiologicalMarc Levitt33:35 ↗
Rectal prolapse more than 3 millimeters should be treated because it causes bleeding, mucus, and can inhibit bowel control in patients with good muscle potential.
clinicalMarc Levitt34:14 ↗
Circumferential prolapse can be trimmed in two separate ambulatory sessions (half circumference each), avoiding hospitalization and eliminating need for dilation since half the circumference remains untouched.
clinicalMarc Levitt34:48 ↗
Perineal body dehiscence is the most common cause of reoperation in female ARM repairs.
clinicalMarc Levitt36:03 ↗
Complete anterior rectal wall mobilization to the areolar plane between rectum and vagina is essential to avoid tension on the anoplasty that can lead to perineal body dehiscence.
clinicalMarc Levitt35:41 ↗
Clear liquids only for one week postoperatively prevents hard stool formation while allowing more stool volume, showing good perineal body healing results without traditional 7-day NPO period.
clinicalMarc Levitt36:45 ↗
If perineal body dehiscence is recognized on days 5-8, taking the patient back to OR to re-suture can salvage the repair; by 3-4 weeks the entire perineal body is dehisced and unsalvageable.
clinicalMarc Levitt37:48 ↗
During laparoscopic approach for high rectums, the IMA must be preserved because prior colostomy may have disrupted collaterals down the left colic, making the rectum completely dependent on IMA blood supply.
clinicalMarc Levitt39:33 ↗
Continence potential in ARM patients is predicted by three factors: original malformation type, sacral ratio, and spine quality (ARM continence index). Three A's predicts continence, three C's predicts incontinence.
clinicalMarc Levitt42:14 ↗
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