A Perineal Fistula With Scrotal Pearls

Case presentation

A male newborn was referred to our department with an imperforate anus. He was delivered vaginally at 39 weeks gestation. His birth weight was 3480 g. The pregnancy was followed up regularly. One day after birth, the pediatrician re-examined the perineum and found an imperforate anus, as he had several regurgitations and was not passing meconium. He was transferred to the regional tertiary hospital.

On examination, the abdomen was distended but not painful. A drop of meconium led to the diagnosis of a subcutaneous perineal fistula associated with “scrotal pearls” ([Fig. 1]). The pouch-perineal distance on invertogram and ultrasound was one centimeter ([Fig. 2a, b]). Routine laboratory tests were normal.

Fig. 1 Subcutaneous perineal fistula (white arrow), associated with “scrotal pearls” (white ellipse) and an imperforate anus (blue rectangle).

Fig. 2 a Invertogram and b perineal ultrasound scan showing the rectal pouch (yellow star) and the distance between the rectal pouch and the skin (white double arrow and cross).

We performed a mini posterior sagittal anorectoplasty and excised the scrotal pearls ([Fig. 3]). Postoperatively, the patient had anal stenosis, which we treated with iterative anal dilatations using Hegar candles. After four years of follow-up, the patient is doing well.

Fig. 3 Mini posterior sagittal anorectoplasty (black arrow) and the excised scrotal pearls (black ellipse).

Publication History

Article published online:
03 April 2025

• References

• 1 Soyer T, Karabulut AA, Boybeyi Ö. et al. Scrotal pearl is not always a sign of anorectal malformation: median raphe cyst. Turk J Pediatr 2013; 55: 665-666
• 2 Kesler SS, Glazier DB, Zaontz MR. et al. Meconium pearls in the scrotum. J Urol 2000; 164: 1350-1351