A 6.5-year-old girl with severe constipation since infancy, unresponsive to macrogol. Pelvic MRI revealed a presacral mass, tethered cord, megarectum and sacral anomalies - features consistent with Currarino syndrome. Surgical management included protective colostomy, excision of presacral teratoma and anorectal reconstruction. Despite treatment, persistent constipation with encopresis led to further evaluation, revealing a stenotic funnel-shaped anus and vaginal septum; rectal biopsies were not feasible due to access limitations. The case highlights a complex anorectal malformation with features suggestive of underlying spinal dysraphism.