We had two cases of female complicated anorectal and genital malformations which underwent total mobilization of all structures of perinea to midline.Case1:A 6 month old female with skin covered bladder, pubic diastasis, ectopic anus, vagina, and urethra to the right side of median cleft and lipoma on the left side. Closure of pubic diastasis with iliac osteotomy and double barrel sigmoid colostomy was done at 8 months age. In the second operation, right displaced anus, vagina and urethra and the entire muscle complex underwent total mobilization to the midline.Case2:An 8 Month old female with complicated anorectal malformation who underwent double barrel colostomy on day 8 of birth. Median cleft lipoma was excised and total mobilization of anus, urethra, right hemivagina and muscle complex to the midline was done and the two hemivaginas were sutured together.Unusual and bizarre anatomic arrangements can be seen in this group. Each case represents a unique challenge for the surgeon, with a different prognosis and therapeutic implications. No general guidelines can be drawn for the management of these patients. Each case must be cared for individually
