Anorectal malformations presenting with colorectal perforation: Frequency, associated morbidity and mortality

Abstract

AimColorectal perforations (CRP) in patients with anorectal malformations (ARM) are infrequently encountered because of their early diagnosis and treatment. Despite recently‐improved neonatal management; CRP during the neonatal period is still a major problem for paediatric surgeons. The aim of the present study was to evaluate the frequency of bowel perforation with ARM in our locality, and the associated morbidity and mortality.Patients and MethodsDuring May 2002 and April 2012, a prospective study was conducted on 416 neonates suffering from ARM (277 high ARM, and 138 low ARM), who presented to Assiut University Children Hospital. The inclusion criteria were all neonates with CRP only related to acute obstruction caused by ARM.ResultsOnly seven cases fulfilled the inclusion criteria. Their age at presentation ranged from 3 days to 14 days. Five neonates had high ARM, while two had low ARM. The diagnosis of bowel perforation was suspected preoperatively in four cases, and was accidentally discovered either intraoperatively in two cases with high ARM or after the anoplasty for low ARM. Two mortalities were encountered; both had a complicated postoperative course with postoperative sepsis and disseminated intravascular coagulation.ConclusionsAlthough rare, colorectal perforation in ARM should always be suspected in delayed ARM presenters. Close postoperative observation is very important to detect any late postoperative perforation.