Revisiting Imperforate Anus in Delivery Rooms

Excerpt

An anorectal malformation (ARM; Fig. 1a) was detected during the initial examination of the male newborn infant (39 weeks & 3500 g, 50–90 centile) in the cesarean delivery room. This imperforate anus was present without a fistulous gut communication in the infants’ perineal area. No meconium passage could be visualized. The newborn was admitted in the neonatal intensive care unit for surgical correction. His baseline hematological investigations (complete blood count, kidney function test, blood gas and blood sugar) were unremarkable. A prone cross-lateral radiograph before the surgery suggested a widened gap between the perineal skin and distal bowel, a high ARM (Fig. 1b). The infant was kept nil orally, and a prompt surgical intervention creating a stoma in situ (Fig. 2) was undertaken at 24 h of age. Post-operatively, the infant was fed after clinically ascertaining the stoma function and gradually increased to full enteral feeding over a few days. This facilitated an uncomplicated stay of the newborn in the intensive care unit and a hospital discharge on exclusive breastfeeding. Subsequently, in the second half of infancy, a second surgery was undertaken as a laparoscopic anorectal pull-through surgery with serial dilatations of the anal canal. This is usually done when the infant has gained a higher weight. The infant is placed in long-term pediatric surgical follow-up care for bowel continence rehabilitation.

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