On initial examination, a male newborn has the finding shown in Fig 1.

The infant was placed nil per OS (NPO) and a large-bore nasogastric tube was placed to low-intermittent suction to decompress the stomach. Total parenteral nutrition was initiated for nutritional support. His glucose levels were monitored and found to be normal. The pediatric surgical team was consulted. Vital signs were as follows:

A chest radiograph obtained on admission to the NICU revealed retained lung fluid. On the day of birth, renal and head ultrasonography scans were normal. A prone cross-table lateral radiograph was obtained at 24 hours of age (Fig 4). Later that day, a colostomy and mucous fistula were placed to relieve intestinal obstruction caused by the imperforate anus.

At 2 days of age, the infant was noted to have decreased urinary output and an indwelling urinary catheter was placed. It was observed that...

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