Text Box: SYNCHRONOUS TREATMENT OF LARGE OMPHALOCELE AND HIGH IMPERFORENTE ANUS IS A CHALLENGE TO PEDIATRIC SURGEONS. WE PRESENT SUCH A RARE CASE AND ITS SUCCESSFUL MANAGEMENT Wu Wenhua, Tan Jianzhong, Qiu Yuhong, Wang Enli, Lin Qifa Shengzhen Women and Children’s Hospital, China A full-term male infant was born in Feb.28, 2000, 3.5kg in weight, with a large omphalocele measuring 7x7x5cm.The overlying transparent amnion membrane was intact. The liver and intestine could The umbilical cord located on the top of the sac and was ligated before admission. The patient had a bilious vomiting and had not discharge of meconium. On clinical investigation, a high imperforate anus was confirmed. An upside-down x-ray film taken at 24 hours of life showed that the distal rectal pouch was above the pubococcygeal line, located approximately 4cm above the skin of perineum. No other associated malformation was found. Nonoperative treatment of omphalocele: To avoid any damage of the amnion membrane, it was sterilized and then covered with a layer of Vaseline gauze. Next was a layer of gauze soaked with 0.5% Mercurochrome. Some sterilized dry gauzes were put on all side of the sac. A sterilized gauze roller bandage was wrapped first around the sac with moderate pressure, then behind the infant’s lumbar area and over the top of the sac to fix the wrapt sac. The dressing was gently to avoid respriatory pressure and inadequate venous reflux. The dressing was replaced once daily in the first week, then twice a week for one month. Gradually, the sac contents were returned into the abdomen. Part of the membrane formed solid scar. Epithelialization then occurred. The abdomen wall defect became smaller and smaller. During this treatment period, the hepatic and renal functions were normal. At the 10th month of life the fascial defect was 2 cm in diameter, which might heal spontaneously or could be repaired operatively. Posterior sagittal anorectoplasty for high anorectal anomaly: On the second day of life, under caudal anesthesia, the patient was placed in left lateral position. A midsagittal skin incision was made from the coccyx to the anal dimple. The dissection was carried down through the subcutaneous and superficial external sphincter inserting on the tip of the coccyx. For exposing, the coccyx was split. 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. Interrupted sutures were placed in the edges of the superficial external sphincter muscle. The skin was closed and a triangular-flap anoplasty completed. The intraoperative blood loss was 30 ml. No blood transfusion was needed. The patient began passing stool and was breast-fed on the next day and was discharged on postoperative day 6. Routine dilations were carried out for more than 6 months. On follow -up, the patient discharged stools twice a day with normal bowel movement and no soiling. He weighted 10 kg at the12th month. 1714