Pediatric Surgery International

, Volume 35, Issue 9, pp 989–997 | Cite as

Management of fetal extraperitoneal rectal perforation: a case series and review of the literature

  • R. Charlton
  • G. Brisighelli
  • T. Gabler
  • C. Westgarth-Taylor
Original Article



Fetal extraperitoneal rectal perforation (FERP) is an extremely rare entity. The objective of this report is to review the available literature on this condition and to add our experience with four additional cases managed at our institution.


A literature search was performed for journal articles addressing this condition. Management strategies and outcomes were then analysed, together with additional information provided from retrospective record review of four cases managed at our institution.


A total of 18 patients were identified and included, 14 from the literature and 4 from our records. Initial investigations varied between authors with contrast enema being the most frequently performed study (7/18). All patients were treated with faecal diversion via colostomy formation. Exploratory laparotomy was performed in 6 cases, perineal debridement and washout in 9 cases while drains were left in situ in 14 cases. At 3–6 months of age, a distal contrast study was performed before closure of colostomy.


Although FERP is a rarely encountered clinical condition, timely recognition and appropriate management can result in good outcomes. Diagnosis can be achieved based on clinical and abdominal X-ray features alone. General management principles involve a diverting colostomy and extended drainage with closure of the colostomy 3–6 months later.


Fetal extraperitoneal rectal perforation Diverting colostomy Meconium cyst 



  1. 1.
    Pitcher GJ, Davies MR, Bowley DM, Numanoglu A, Rode H (2009) Fetal extraperitoneal rectal perforation: a rare neonatal emergency. J Pediatr Surg 44(7):1405–1409. CrossRefPubMedGoogle Scholar
  2. 2.
    Garge S, Chacko A (2017) Fetal extraperitoneal rectal perforation: a case report. Ann Pediatr Surg 13(2):104–106. CrossRefGoogle Scholar
  3. 3.
    Sundararajan L, Patel D, Jawaheer G (2008) Antenatal rectal perforation presenting in the neonate. Pediatr Surg Int 24(5):601–603. CrossRefPubMedGoogle Scholar
  4. 4.
    Ibrahim AA et al (2011) Fetal extraperitoneal rectal perforation in a preterm baby. Eur J Pediatr Surg 21:343–345. CrossRefPubMedGoogle Scholar
  5. 5.
    Levitt MA, King SK, Bischoff A, Alam S, Gonzalez G, Pena A (2014) The Gonzalez hernia revisited: use of the ischiorectal fat pad to aid in the repair of rectovaginal and rectourethral fistulae. J Pediatr Surg 49(8):1308–1310. CrossRefPubMedGoogle Scholar
  6. 6.
    Lockwood C, Ghidini A, Romero R, Hobbins JC (1988) Fetal bowel perforation simulating sacrococcygeal teratoma. J Ultrasound Med 7(4):227–229. CrossRefPubMedGoogle Scholar
  7. 7.
    West DK, Touloukian RJ (1988) Meconium pseudocyst presenting as a buttock mass. J Pediatr Surg 23(9):864–865. CrossRefPubMedGoogle Scholar
  8. 8.
    Davies MR, Cywes S, Rode H (1984) Prenatal perforation of the extraperitoneal part of the rectum, associated with a developmental defect of the pelvic floor. Z Kinderchir 39(4):271–273. CrossRefPubMedGoogle Scholar
  9. 9.
    Tan YW, Motiwale S (2010) Fetal extraperitoneal rectal perforation presenting after duodenal atresia repair. J Pediatr Surg 45(12):2447–2449. CrossRefPubMedGoogle Scholar
  10. 10.
    Mitsudo SM, Boley SJ, Rosenzweig MJ, Campbell DE (1983) Extraperitoneal pelvic meconium extravasation in a newborn infant. J Pediatr 103(4):598–600. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • R. Charlton
    • 1
  • G. Brisighelli
    • 1
  • T. Gabler
    • 1
  • C. Westgarth-Taylor
    • 1
  1. 1.Department of Paediatric SurgeryChris Hani Baragwanath Academic Hospital, University of the WitwatersrandJohannesburgSouth Africa

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