Management of male H-type anorectal malformations

Abstract

H-type anorectal malformations (ARM) are extremely rare in males. Herein, we have described our experience of managing this variety. From September 1993 to February 2009, seven boys with H-type ARM were managed in the Department of Pediatric Surgery, Chittagong Medical College and Hospital, Chittagong, Bangladesh. Clinical features, operative procedures and outcomes were analyzed. Age ranged from 1 day to 4 years. The passage of meconium was seen in urine of four boys, through ectopic openings in the perineum in three boys. One patient had a round worm passing through an ectopic opening. Three boys' perineum showed meconium dots/streak along scrotal raphe. Anus was absent in all. Two patients had rectopenilurethral (RPU) and rectoscrotal (RS) fistula; two boys had anoscrotal and anoperineal fistula; one boy had pinhole anus with RS and RPU fistula. One boy had rectoperineal and RS fistula. One patient had rectobulbar urethral fistula with meconium filled chamber between the two hemiscrotum. Two boys had associated anomalies. Five boys had primary procedure with anterior sagittal approach-anoplasty (ASAP) and anorectoplasty (ASARP). Two patients had pelvic colostomy and ASARP in one and PSARP in one. One patient died postoperatively. One boy developed anal stenosis and needed redo. Five children have regular bowel movements and they are growing well. Thorough clinical examination may identify the anatomical variations of male H-type ARM, and for the treatment of which primary ASAP or ASARP gives good results.