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PATTERN OF ANORECTAL MALFORMATIONS AND EARLY OUTCOMES OF MANAGEMENT AT MOI TEACHING AND REFERRAL HOSPITAL
Insights
Anorectal malformations (ARM) present significant challenges, with late diagnosis common in Kenyan infants. Early identification and management are crucial for improving outcomes in these complex congenital conditions.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Abnormalities
Background:
- Anorectal malformations (ARM) represent a spectrum of congenital anomalies affecting the terminal portion of the gastrointestinal tract.
- Timely diagnosis and appropriate surgical intervention are critical for optimizing patient outcomes and reducing morbidity.
Purpose of the Study:
- To delineate the anatomical subtypes of Anorectal malformations (ARM).
- To describe the management strategies employed for ARM.
- To report the early outcomes, including morbidity and mortality rates, for ARM patients.
Main Methods:
- A prospective study was conducted over 16 months at Moi Teaching and Referral Hospital (MTRH).
- Infants diagnosed with ARM were prospectively enrolled from November 2011 to April 2013.
- Data collected included ARM subtypes, coexisting abnormalities, management, morbidity, and mortality.
Main Results:
- Forty-two infants with ARM were studied, with a male predominance (57%).
- Predominant subtypes included imperforate anus without fistula in males and rectovestibular fistula in females.
- Mortality was high at 31%, often associated with coexisting abnormalities; common morbidities included colostomy complications and wound infections.
Conclusions:
- Patients with Anorectal malformations (ARM) frequently present late for medical attention at MTRH.
- Diagnosis is often missed at birth, particularly for infants born outside healthcare facilities or even within them.
Unlabelled:
Objectives: To describe the anatomical sub-types of Anorectal malformations, their management and the early outcome at Moi Teaching and Referral Hospital (MTRH) over a 16 month period. Design: A prospective study.
Setting:
MTRH, in the neonatal Unit and paediatric surgical wards for theinitial capture of patients and initial follow up. The Paediatric Surgical out-patient clinic was used for the subsequent follow ups.
Subjects:
All infants diagnosed with ARM (Anorectal malformations) at MTRH from November 2011 to April 2013.
Main Outcome Measures:
Sub-types of the Anorectal malformations, coexisting abnormalities morbidity and mortality rates.
Results:
There were 42 participants including 24 (57%) males and 18 (43%) females. Neonates presented at an average age of 4 ± 3, three days and older children presented on average age of 152 ± 118, three days. There were 30 (71%) neonates and 12 (29%) older infants. In males, the predominant sub-type was imperforate anus without a fistula found in ten participants (42% of males). In females, the predominant sub-type was recto-vestibular fistula found in 14 participants (78% of females). Mortality occurred in 13 (31%) participants among them ten (24%) had coexisting abnormalities. The main causes of morbidity were: colostomy complications in four (9.5%); wound,infections in one (5%); and wound dehiscence in one (5%).
Conclusions:
Patients with Anorectal malformations presented late at MTRH. The diagnosis at birth was missed in babies born at home as well as those delivered in health institutions.
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