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Anorectal Malformation

Anorectal Malformation

Anorectal malformations are birth defects, where, the anus and rectum (the lower end of the digestive tract) do not develop properly. This results in an absent anal opening or variants of same.

What are the different types of Pediatric Anorectal Malformation (Imperforate Anus)?

Anorectal anomalies are classified into numerous forms, including:

  • ANAL STENOSIS

Narrow anal passage

  • RECTAL ATRESIA

The rectum does not connect to the anus

  • ABSENT ANAL OPENING

 also called as Imperforate Anus

  • CLOACAL ABNORMALITY

urethra vagina and rectum communicate

How Are Anorectal Malformations Diagnosed Clinically?

Anorectal abnormalities in neonates usually characterised by

  • Absent anal opening
  • Constipation
  • Abdominal distension
  • Failure to thrive
  • CT-INTRAVENOUS PYELOGRAPHY/MR UROGRAPHY

What are anorectal malformation associated with?

  • The VACTERL association

A syndrome in which there are Vertebral, Anal, Cardiac, Tracheal, Esophageal, Renal, and Limb abnormalities

  • Abnormalities of the urinary tract
  • Abnormalities of the spine

What are the diagnostic test for anorectal malformations?

  • Abdominal X-rays.

This shows dilated bowel loops. It also tells us about associated spinal abnormalities

  • Cross table Prone Lateral films:

A specialised X ray used to diagnose the level of termination of the Rectum. The surgical treatment is based on this Xray.

  • Abdominal ultrasound (also called sonography)

This is done usually to rule out associated abnormalities

  • Distal Loop Colostogram.

This study delineates the position of fistula and shows the communication of rectum with urethra.Based on this the severity of anorectal malformations is decided.This divides the anomaly in LOW,INTERMEDIATE and HIGH VARIANTS.This is usually done via the lower loop of the colostomy.

What are the treatment options for Anorectal Malformation?

The treatment for ANORECTAL MALFORMATION can be single or multi staged based on the severity of disease.

In minor conditions called as LOW ANORECTAL MALFORMATIONS, a single procedure termed ANOPLASTY suffices.

In INTERMEDIATE VARIETIES OF ANORECTAL MALFORMATIONS ,in uncomplicated situations, a surgery called PRIMARY POSTERIOR SAGGITAL ANORECTOPLASTY(PSARP)

In HIGH ANOMALIES, a staged procedure is used.

First stage : COLOSTOMY

Second Stage : POSTERIOR SAGGITAL ANORECTOPLASTY(PSARP)

Third Stage : COLOSTOMY CLOSURE

COLOSTOMY

In this surgery the large intestine is temporarily brought out through a lower abdominal incision.The pediatric surgeon teaches mother regarding care of the colostomy

ANORECTAL RECONSTRUCTIVE SURGERY, also known as posterior sagittal anorectoplasty (PSARP), is done to connect the rectum to the anal hole and cover any aberrant openings that may interfere with the ability to have a regular bowel movement. In cases where there is an absence of an anal opening, your surgeon will create a new one.

The majority of PSARP treatments are done on babies aged one to six months. The kind of PSARP done will be determined by the location of the rectum and anus (low or high), the function of the sphincter muscles, and the presence of any aberrant holes (called fistulas) that need to be fixed.

COLOSTOMY CLOSURE

Your child’s colostomy will remain in place for approximately eight weeks following the reconstructive surgery to allow the rectum and anal opening to heal before coming in contact with any waste. The colostomy will be medically closed when your child is ready and totally recovered. Within a few days, they will be able to pass stools on their own via the anus. Initially, stools will be loose and frequent. Safe topical remedies should be used to protect your child’s skin against diaper rash and discomfort. Your child’s stools will normalize as they recover, becoming firmer and less frequent.

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