In mild to intermediate cases, pediatric surgeons reposition the rectum to its proper location or construct one for a child born without an opening. Depending on the circumstances, surgery may be performed between birth and three months of age. If, for example, an infant does not have an opening where the anus should be and there are no other serious birth defects, he or she may have surgery during the first week of life. Surgeons use natural tissue from the body to construct, reconstruct or reposition the anus and rectum where they belong, allowing stool to pass normally.

In more difficult cases, physicians at Riley at IU Health need to fully evaluate a child’s complicated anatomy before choosing a course of treatment. Babies are tested by ultrasound and contrast X-rays of the rectum and urinary system to show anatomy. 

If a baby has a complicated anatomy, one of the first surgeries may be an ostomy-a created opening that diverts feces into a bag outside the body by bringing a portion of the intestine to the surface. The creation of an ostomy offers surgeons time to decide the best approach and timeline for repairing the anatomy. We can tend to other more life-threatening conditions, if necessary, and give babies more time to grow before any reconstructive surgery. During this wait, we observe the baby very closely to confirm bodily waste is moving through the intestines to the ostomy normally. We also monitor each child to make sure he/she is thriving.

The most complicated cases may not be treated until a child is at least a year old. Boys may have undescended testes or malformation of the penis. Girls may have an unformed cervix and uterus, or two halves of a uterus that do not form as a whole organ. These babies often require pediatric general surgeons to repair the rectum and intestinal tract, and pediatric urologists to reconstruct genitals and the urinary tract.