Congenital recto-anal malformation is a malformation of the gastrointestinal tract caused by impaired development of the hindgut during the embryonic period, and is a common disease in pediatric anorectal surgery, accounting for the first place of congenital gastrointestinal malformation. The incidence rate is 1:1500-5000, and the survey data in China shows that it is about 1:4000, and there is no difference between male and female incidence. About 50% of congenital recto-anal malformations are accompanied by fistula formation between the rectum and the genitourinary system. The vast majority of children with recto-anal malformations have no anus in the normal position and are easy to detect. The most important thing is that the patient’s body is not a fistula, but a fistula that is not accompanied by a fistula. The fistula may not show symptoms of intestinal obstruction for a period of time after birth, but gradually develop defecation difficulties in a few weeks to a few years. In children with high rectal atresia and normal anus and anal canal, there is no meconium discharge or cloudy fluid from the urethra. Girls often have vaginal fistulas. Urinary tract fistulas are almost always seen in boys. The main symptoms of recto-urethral fistula are discharge from the urethra and meconium. Diagnosis: The diagnosis is mostly uneventful. There is no meconium discharge after birth and no anus on examination. The diagnosis can be established. Rectal atresia with a normal anal canal can also be determined by rectal finger examination. Vaginal flow of feces indicates vaginal fistula; urethral fistula when the urethral opening does not vent and discharge feces with urination movements; bladder fistula when there is feces throughout urination and the urine is green. The type of recto-anal malformation can mostly be clarified by supplementing with imaging examinations. Imaging: The diagnosis of congenital rectoanal malformation is not difficult, but imaging is needed to determine the height of rectal atresia, the relationship between the end of the rectum and the puborectalis muscle, and the presence or absence of urinary fistula. The x-ray inversion radiography can understand the location of gas shadows at the end of the rectum and determine the location of the deformity. The line between the pubic bone and the sacrococcygeal joint on the inverted lateral view is called the Pc line, which corresponds to the plane of the puborectalis muscle and is used to distinguish between high, intermediate and low deformities. Fistulogram shows the direction, length and thickness of the fistula. Ultrasound is more accurate than x-ray in localizing the end of the rectum. Magnetic resonance imaging is also gradually used in clinical applications, which is accurate and reliable. However, the price is higher. Treatment: The treatment differs according to the type of rectal anorectal malformation, but all must be treated surgically. Anal canal rectal atresia should be operated immediately after birth. Surgery for low-level anomalies is relatively simple and can be done mostly through a perineal approach. In simple atresia, only the anal membrane is removed and the rectal mucosa is sutured to the anal skin. For anal canal atresia, the blind end of the rectum can be freed, dragged out through the anus, sutured with the anal skin, and performed anal canalplasty. High deformity requires anorectoplasty through the abdomen, perineum or posterior sagittal incision. Surgical principles: 1) free the blind end of the rectum; 2) remove and repair the fistula if it is combined with a fistula; 3) anorectoplasty. In general, colostomy is performed first, and the second stage of surgery is performed after 6—12 months.