Photo 1: An 8-week-old female pug with type 1 atresia ani. A blunt probe is inserted into the stenotic canal. The ducts of
the anal sacs are visible.
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Atresia ani is a congenital embryological anomaly in which the hindgut fails to fully communicate with the perineum. The anus
may be either stenotic or imperforate; atresia ani may appear alone or in combination with rectovaginal or rectovestibular
fistula (RVF). In dogs, females and certain breeds including poodles and Boston Terriers are predisposed. There are few reports
of atresia ani in cats, and most are females with concurrent RVF.
Photo 2: Illustration of type II atresia ani with RVF. The communication allows feces to exit the vulva.
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Atresia ani consists of four types of anomalies of worsening severity. Type I is congenital anal stenosis without imperforate
anus (Photo 1). Type II and III anomalies constitute an imperforate anus a distance of either < 1.5 cm (type II) or > 1.5
cm (type III) away from a blind rectal pouch (Photo 2). Type IV anomalies are rare and involve a blind rectal pouch with normal
terminal rectal development.
Clinical signs and diagnosis
Photo 3: Contrast vaginogram from a 10-week-old Boston Terrier illustrates a wide communication between the dorsal wall of
the vestibule and the rectum.
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Puppies and kittens affected with atresia ani are often stunted and anorectic and have abdominal enlargement due to secondary
megacolon. In patients with atresia ani alone, defecation is reduced (type I) or absent (types II to IV). Newborn puppies
and kittens with atresia ani and confluent RVF may present with a history of chronic recurrent cystitis. Passage of feces
from the vulva is the hallmark sign in females.
Photo 4A: An 8-week-old Jack Russell Terrier with an imperforate anus and RVF. A mosquito hemostat easily communicates with
the rectal lumen, and the tip outwardly deflects the anal membrane.
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A contrast vaginogram is often helpful in determining the length and width of the communication in cases with concurrent RVF
(Photo 3). Under deep sedation or general anesthesia, a curved hemostat can be inserted into the vulva to help identify the
communication with the rectum (Photo 4A).
Surgery and prognosis
Photo 4B: The rectovaginal communication is closed with hemostatic clips.
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Surgery to correct atresia ani is often delayed until 6 to 8 weeks of age. Fine instruments such as jewelers' forceps and
tenotomy scissors are used to carefully dissect the skin of the anus inwardly and identify the rectal pouch. Rectal vaginal
fistulas vary in depth and width of communication. Various authors have ligated, transected and oversewn or used hemostatic
clips to attenuate the communication (Photos 4B, 4C).
Photo 4C: The appearance of the anoplasty 10 days postoperatively.
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Complications after surgery include fecal incontinence, persistent megacolon, anal stricture and recurrent cystitis. In one
study, three of six dogs that underwent anoplasty needed either revision or subtotal colectomy. The prognosis for patients
with atresia ani with concurrent RVF appears better than those cases with atresia ani alone. The main concern in those cases
is not persistent megacolon but rather persistent urinary tract infection. Preservation of the RVF for reconstruction of the
anal canal and the anus in atresia ani with RVF was successfully performed in two dogs and might be a method of reducing postoperative
incontinence.
SUGGESTED READING
> Vianna ML, Tobias KM. Atresia ani in the dog: a retrospective study. J Am Anim Hosp Assoc 2005:41(5):317-322.
> Mahler S, Williams G. Preservation of the fistula for reconstruction of the anal canal and the anus in atresia ani and rectovestibular
fistula in 2 dogs. Vet Surg 2005;34(2):148–152.
Dr. Gary Ellison is an ACVS Diplomate and professor and service chief of small animal surgery at The University of Florida College of Veterinary
Medicine in Gainesville. When not working, he enjoys bicycling and automechanics.
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