Objective        To investigate and summarize the accurate diagnosis for the male neonates with high and intermediate imperforate anus and accompanied malformations in order to provide reference for the surgical treatment options and prognostic evaluation.        Methods        Clinical symptoms

laboratory findings and accompanied malformations of 29 male neonates with intermediate and high imperforate anus (aged 5 h to 51 d

mean 3.06 d) were retrospective analyzed. The clinical characteristics and supplementary examinations for accurate diagnosis for the distance between rectal blind end and anal fossa

and the associated congenital defects were summarized.       Results        (1) Abdominal distension and vomiting were common clinical manifestations in these 29 cases

while

the meconium from the urethral discharge were only found in 6 cases with fistula before surgery. (2) The distance between rectal blind end and anal fossa was 28.08±16.03

14.29±7.30

26.59±14.45 and 27.54±15.96 mm respectively when it was measured by lateral upside-down plain X-ray film in abdomen

perineal high-resolution ultrasonography

colon distal colostography

and during operation. The result measured by perineal ultrasound image was significant different from that by X-ray film

distal colostography

or during surgery (all P0.05). But

there was no statistically difference in the distance measured through X-ray film and colostography with it during operation (P0.05). (3) The most common accompanied malformations were cardiovascular system malformation

genitourinary defects and spinal anomalies in the cohort. Some cases with cardiac malformation and genitourinary anomalies were self-healed. But

some spinal defects might affect the defecation function even after operation.       Conclusion        Distal colostography is superior to upside-down plain X-ray film in the prediction of the distance between rectal blind end and anal fossa

with the results of the former more close to those measured during operation. At first visit

surgical treatment options should be based on comprehensive consideration on clinical manifestations

upside-down plain X-ray film and accompanied malformations. Dstal colostography could provide important reference for anoplasty. The associated congenital defects should be closely followed up

especially some spinal defects which might affect the defecation function after operation.