Abstract
Anorectal malformations are defined by the relationship of the rectum to the sphincter complex and can be classified as high and low anomaly based on whether meconium is present or absent, presence of dimple, anocutaneous reflex, sacral abnormality or presence of meconium in urine. The diagnosis should be made in the delivery room by inspecting the perineum. Meconuria with absence of anal opening invariably indicates a high malformation which requires a colostomy in the newborn period. Low malformations do not become evident until 24 hours when the meconium may show up in the perineal fistula. These defects can be managed by a perineal anoplasty without a colostomy in the newborn period. A prone cross table lateral shoot abdominal film is required if clinical information at 24 hours is insufficient to decide whether a colostomy is needed. We present a case of newborn, day 4 of life, who did not pass meconium since birth, had abdominal distension, vomiting, poor feeding and lethargy since last 2 days. Anal area showed pigmentation with presence of median raphe, anal dimple and slightly formed anal opening. Baby was initially thought as a case of low type imperforate anus. On further evaluation, was found to have meconuria too. Invertogram done showed high type defect. Rest of the examination was normal. Supportive therapy was initiated and baby underwent transverse loop colostomy for high type imperforate anus on day 5 of life. So it is always advisable to confirm the type of anorectal malformation both clinically and by doing required investigation before deciding for any operative intervention like colostomy or anoplasty, as clinical examination and investigation may not correlate in all occasions. Evaluation should also include screening out for associations and other sacral anomalies. BJHS 2018;3(2)6: 500-503.
Highlights
Anorectal malforma ons are defined by the rela onship of the rectum to the sphincter complex which includes a mass of muscle fibres surrounding the ano rectum.[1]
Meconuria with absence of anal opening in the perineum invariably indicates a high malforma on which requires a Agrawal T et al colostomy in the newborn period.[3]
We present a case report of a newborn male who presented to our hospital, was ini ally suspected with low type imperforate anus, inves ga ons and further evalua on revealed it to be high type malforma on, so baby underwent colostomy and subsequent management
Summary
Anorectal malforma ons are defined by the rela onship of the rectum to the sphincter complex which includes a mass of muscle fibres surrounding the ano rectum.[1]. The diagnosis should be made in the delivery room by inspec ng the perineum-no anal opening is found.[3] The step is observing for passage of meconium in urine.[3] Meconuria with absence of anal opening in the perineum invariably indicates a high malforma on which requires a Agrawal T et al colostomy in the newborn period.[3] Low malforma ons do not become evident un l 24 hours when the meconium may show up in the perineal fistula.[3] These defects can be managed by a perineal anoplasty without a colostomy in the newborn period.[3] Some mes if there is doubt clinically, a prone cross table lateral shoot abdominal film is required if clinical informa on at 24 hours is insufficient to decide whether a colostomy is needed.[2] The distance of rectal gas from the skin marker is measured.
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