A 6-week-old male with anorectal malformation (imperforate anus) is found to have no fistula visible on perineum. Cross-table lateral X-ray taken at 24 hours of life shows rectal gas bubble 2 cm above the perineal skin. The Krickenbeck classification would categorize this as:
- A Perineal fistula — amenable to primary anoplasty
- B Vestibular fistula in males
- C High ARM — requires staged repair with colostomy first ✓
- D Recto-urinary fistula needing PSARP
Explanation
The Krickenbeck international classification for anorectal malformations (2005) categorizes ARMs based on type and is used for surgical planning. On invertogram/cross-table lateral X-ray, the distance from the gas bubble to the perineal skin: <1 cm indicates a low (perineal) lesion potentially amenable to primary perineal anoplasty; >1 cm indicates a high or intermediate lesion requiring a staged approach — initial defunctioning colostomy (usually sigmoid colostomy), followed by definitive PSARP (posterior sagittal anorectoplasty) at 3-6 months, then colostomy closure. At 2 cm above perineal skin, this is a high ARM requiring staged repair.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.