case_images: PMC9904968_01
case_images: Physical exam reveals rudimentary genital folds, which, when retracted, reveal a small, single perineal opening. There is no anal opening, but there is a gluteal fold with a dimple at the site of anal sphincter.
case_images: 10-1055-s-0043-1761206-i2022050661cr-1.jpg
case_images: PMC9904968_01_10-1055-s-0043-1761206-i2022050661cr-1.jpg
case_images: FI2022050661cr-1
case_images: The physical examination showed rudimentary genital folds with a single perineal opening, no anal opening, and a gluteal fold with a dimple at the site of the anal sphincter ( Fig. 1 ). The VACTERL workup was negative except for an atretic right kidney and left grade IV vesicoureteral reflux.
case_images: The cloacagram shows an atretic common channel, an atretic urethra, a single small vagina, and a rectum below the pubococcygeal line.
case_images: 10-1055-s-0043-1761206-i2022050661cr-2.jpg
case_images: PMC9904968_01_10-1055-s-0043-1761206-i2022050661cr-2.jpg
case_images: FI2022050661cr-2
case_images: A cloacagram showed an atretic common channel, a single small and high vagina, and a rectum below the pubococcygeal (PC) line ( Fig. 2 ). 
case_images: For a rectal patch, the megarectum is divided longitudinally with care to preserve its blood supply.
case_images: 10-1055-s-0043-1761206-i2022050661cr-3.jpg
case_images: PMC9904968_01_10-1055-s-0043-1761206-i2022050661cr-3.jpg
case_images: FI2022050661cr-3
case_images: For the rectal patch creation, we cut a rectangle from the anterior rectal wall based on the two perforating mesenteric vessels on either side ( Fig. 3 ).
case_images: The neovagina is reconstructed using the rectal patch, shown here being tubularized over a Hegar dilator. The patch was sutured to the wall of the vagina circumferentially. A 24-French Foley catheter, used for calibration of the rectoplasty, is seen in the rectum.
case_images: 10-1055-s-0043-1761206-i2022050661cr-4.jpg
case_images: PMC9904968_01_10-1055-s-0043-1761206-i2022050661cr-4.jpg
case_images: FI2022050661cr-4
case_images: We made sure the distal extent reached to the area of the clitoris and was healthy and viable ( Fig. 4 ). 