Management of the newborn with imperforate anus. Initial management of imperforate anus by simple dilatation, decompressing colostomy, perineal anoplasty, or combined abdominoperineal pull-through is evaluated in sixty-two patients over a twenty-year period at the Yale-New Haven Hospital.

Abstract

The results of surgical care of 62 newborn infants with imperforate anus are summarized here in a 20-year retrospective study. Ninety per cent had anomalies in either formation of the urorectal septum or failure of posterior, "migration" of the rectum. The over-all mortality rate was 30 per cent, but most of the deaths were in untreated newborns having other severe congenital anomalies. Emphasis in diagnosis is placed on correlating physical findings with some abnormality during a specific phase of embryologic development. The value of upside-down lateral films of the pelvis in determining the initial treatment is de-emphasized. Roentgenograms of the chest, abdomen and lumbosacral spine, and intravenous pyelogram and cystogram, are important to detect the associated, anormalies.The over-all results of perineal anoplasty for a low perineal fistula or obvious perineal bulging are good, which indicates that this is the procedure of choice with such newborns. A combined abdominoperineal pull-through operation following a preliminary colortomy is recommended for infants with high imperforate anus. Eventual function may be satisfactory if there is close supervision of the postoperative patient throghout infancy and childhood to prevent chronic fecal impactions and secondary megacolon.