Anorectal malformation (ARM), one of the most common congenital anomalies, may present with a wide spectrum of defects. Although, female ARM and male children with low ARM may present late, almost all male patients with high ARM present within first few days of life. We present a rare case of a male child with a high ARM with a wide recto-prostatic urethral fistula who presented at one year of age. He had an associated left radial club hand deformity. He underwent 3 staged repair viz. right transverse colostomy, posterior sagittal anorectoplasty and stoma closure. Our patient was wrongly informed to undergo surgical intervention at one year of age by a village doctor. The parents were also ignorant about the pathology. This case highlights the requirement for improvement in not only literacy, but also basic health care, awareness of the general population and the medical fraternity about common congenital anomalies, and an efficient referral system to a tertiary care center, in India.
