Text Box: TREATMENT OF HIGH IMPERFORATE ANUS WITH LARGE OMPHALOCELE IN A MALE NEONATE Wu Wenhua, Tan Jianzhong, Qiu Yuhong , Wang Enli, Lin Qifa Shenzhen Woman and Children’s Hospital, China Objective: We present a successful synchronous treatment of large omphalocele and high imperforente anus in a male neonate. Methods: A full-term male infant was born with a large omphalocele measuring 7x7x5cm. An upside-down x-ray film showed that the distal rectal pouch was 4cm above the skin of perineum.The amnion membrane was covered with a layer of Vaseline gauze. Next was a layer of gauze soaked with 0.5% Mercurochrome. Some dry gauzes were put on all side of the sac. A gauze roller bandage was wrapped the sac, lumbar area and over the top of the sac. Gradually, the contents were returned into the abdomen. Part of the membrane formed solid scar. Epithelialization occurred. On the second day of life, a midsagittal skin incision was made from the coccyx to the anal dimple. The levator could be seen deeper in the wound, arising from the ventral surface of the coccyx to the bladder neck. The rectum was not visible through the wound. To search the rectum, the levator layer was split midsagittally. Between the coccyx and the bladder, the rectal pouch was confirmed by needle aspiration of meconium. Retracting silk sutures were placed in the rectal pouch, which was mobilized downward for 5 cm, pulled through the levator. Then, the rectal pouch was opened, evacuated and fixed between the posterioly divided muscle complex. The bowel was not tapered. A triangular-flap anoplasty was completed. The patient began passing stool and was breast-fed on the next day and was discharged on postoperative day 6. Results: On follow -up, the patient discharged stools twice a day with normal bowel movement and no soiling at the12th month. The fascial defect was 2 cm in diameter, which might heal spontaneously or could be repaired operatively. Conclusion: Such a rare case could be corrected by single-stage modified Pena operation and simply bandaging. 1713