case_images: PMC8276751_01
case_images: The lower part of the muscle complex was retracted down to expose the posterior wall of the rectum.
case_images: 10-1055-s-0041-1728725-i200546cr-1.jpg
case_images: PMC8276751_01_10-1055-s-0041-1728725-i200546cr-1.jpg
case_images: FI200546cr-1
case_images: The muscle complex was identified and its lower part was retracted downward to expose the posterior wall of the rectum ( Fig. 1 ).
case_images: PMC8276751_02
case_images: Anatomy of the patient.
case_images: 10-1055-s-0041-1728725-i200546cr-2.jpg
case_images: PMC8276751_02_10-1055-s-0041-1728725-i200546cr-2.jpg
case_images: FI200546cr-2
case_images: The rectum, which was abnormally dilated until 1 to 2 cm beyond the peritoneal reflection, continued as sigmoid colon whose caliber appeared suddenly normal ( Fig. 2 ).
case_images: Sigmoid colon surgically separated from the dilated rectum.
case_images: 10-1055-s-0041-1728725-i200546cr-3.jpg
case_images: PMC8276751_02_10-1055-s-0041-1728725-i200546cr-3.jpg
case_images: FI200546cr-3
case_images: Mobilized sigmoid colon passed into the posterior sagittal space.
case_images: 10-1055-s-0041-1728725-i200546cr-4.jpg
case_images: PMC8276751_02_10-1055-s-0041-1728725-i200546cr-4.jpg
case_images: FI200546cr-4
case_images: PMC8276751_03
case_images: The center of the sphincter complex is defined using a neurostimulator.
case_images: 10-1055-s-0041-1728725-i200546cr-5.jpg
case_images: PMC8276751_03_10-1055-s-0041-1728725-i200546cr-5.jpg
case_images: FI200546cr-5
case_images: Once the suprapubic incision was sutured and the patient was again in the same prone position as before, a second small inverted cutaneous Y-shape incision was made on the anal dimple, after reconfirming the location of the underlying anal muscle complex using the neurostimulator ( Fig. 5 ).
case_images: Progressive dilation of the tunnel created in the center of the sphincter complex.
case_images: 10-1055-s-0041-1728725-i200546cr-6.jpg
case_images: PMC8276751_03_10-1055-s-0041-1728725-i200546cr-6.jpg
case_images: FI200546cr-6
case_images: Our technique was different from the original technique of PSARP described by Pena and Devries, which envisages to separate the sphincter muscle complex in the midline.  In contrast, we created a tunnel in the center of the sphincter muscle complex through a gentle and progressive dilation of its muscle fibers using Hegar dilators (size 6-12) ( Fig. 6 ) until reaching an acceptable diameter to enable the mobilized sigmoid colon to go through it. 
case_images: The sigmoid colon is passed through the dilated tunnel of the sphincter complex and a neoanus is created.
case_images: 10-1055-s-0041-1728725-i200546cr-7.jpg
case_images: PMC8276751_03_10-1055-s-0041-1728725-i200546cr-7.jpg
case_images: FI200546cr-7
case_images:  Consequently, the sigmoid colon, that managed to pass through the dilated tunnel of the sphincter muscle complex, was sutured to the external sphincter and to the margins of the small Y-shape cutaneous incision that had already been made in the anal dimple by using interrupted absorbable stitches ( Fig. 7 ).The posterior sagittal incision was then closed.
case_images: PMC8276751_04
case_images: Neoanus and neovaginal introitus at 2.6 years of age.
case_images: 10-1055-s-0041-1728725-i200546cr-8.jpg
case_images: PMC8276751_04_10-1055-s-0041-1728725-i200546cr-8.jpg
case_images: FI200546cr-8
case_images: The rectovestibular fistula, that had become the vagina introitus, appeared relatively wide and easily to explore ( Fig. 8 ).