The case report of a 28-year-old man with high imperforate anus and rectourethral fistula (Ladd Type III) is presented. The preoperative findings and operative details are described. The satisfactory result obtained in spite of the patient’s age and the presence of associated vertebral anomalies should encourage attempts at abdominoperineal repair in similar cases. Details of pelvic dissection in an adult with imperforate anus are described, with emphasis upon the problems of greater vascularity and increased depth and narrowness of the pelvis. An alternative method of repair for high imperforate anus, utilizing the sacro-abdominoperineal approach to alleviate some of these difficulties, is suggested. The possibility of using an endorectal procedure in such a case should also be entertained.