“…However, the pathogenesis of this condition remains unclear. The concept of intestinal perforation occurs as a result of distal obstruction is logical; however, like Pitcher et al [1], we could not identify any evidence of distal obstruction, and it seems unlikely that intestinal transit would have generated enough pressure to cause rectal perforation given the duodenal obstruction, even if transient intrauterine rectal/anal obstruction did occur to cause the rectal perforation. Therefore, we are in agreement with Davies et al [2] that the antenatal rectal perforation was more likely a result of a localized ischemic insult after herniation of supralevator rectum through a pelvic floor defect, resembling a Richter's hernia.…”