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Delayed presentation of anorectal malformations in a tertiary care hospital in India
Gali Divya1, Vijay Kumar Kundal2, Pinaki R Debnath1
1Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
Insights
Delayed presentation of anorectal malformations (ARMs) is common, particularly in females, and leads to increased surgical and functional complications. Early diagnosis and management are crucial to prevent adverse outcomes in newborns with ARMs.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Anorectal malformations (ARMs) are congenital anomalies requiring timely intervention.
- Delayed presentation of ARMs can complicate management and impact outcomes.
- Understanding the characteristics and consequences of delayed ARM presentation is vital for improving patient care.
Purpose of the Study:
- To investigate the incidence, management strategies, and outcomes of delayed presentations of anorectal malformations (ARMs).
- To analyze the factors contributing to delayed presentation and their association with surgical and functional complications.
- To emphasize the importance of early diagnosis and appropriate management for improved patient outcomes.
Main Methods:
- A retrospective study was conducted from March 2015 to March 2020.
- Included patients presented with ARMs 7 days after birth.
- Data collected included ARM type, presentation details, associated anomalies, management, and postoperative complications with a minimum 6-month follow-up.
Main Results:
- Out of 102 ARM patients, 44 (43%) presented late, with females more commonly affected (35/44).
- Common associated anomalies included cardiac (18) and renal (8).
- Delayed presentation was associated with higher rates of postoperative complications, notably constipation (47.7%) and fecal incontinence (27.27%).
Conclusions:
- Delayed presentation of ARMs is a significant clinical issue, more prevalent in females.
- Management approaches are similar to early presentations, but staged repair is often necessary for complex cases with chronic constipation and megarectum.
- Rigorous newborn perineal examination is essential for early ARM detection to mitigate associated morbidity and mortality.
Aim:
To study delayed presentation of ARMs, management and its effect on surgical and functional complications.
Methods:
It is a retrospective study from March 2015 to March 2020. All the patients satisfying the criteria of delayed ARMs, i.e., presenting 7 days after birth were included. Information regarding type of ARM, mode of presentation, time of presentation, associated anomalies, management strategy, postoperative complications and functional outcome was noted. Minimum follow-up period was 6 months.
Results:
Out of 102 patients with ARM, 44 patients presented late. Among the 44 patients, 9 were males and 35 were females. Associated comorbidities observed are low birth weight (n = 9) and preterm (n = 13). Associated anomalies observed were cardiac (n = 18), renal (n = 8), other gastrointestinal (n = 5) and skeletal (n = 1). (1) Male: rectourethral fistula-2 (staged repair), anal stenosis-3 (anoplasty) and anocutaneous fistula-4 (anoplasty). (2) Female: vestibular fistula: 15 (6 primary definitive surgery + 9 staged repair), ectopic anus: 3 (staged repair), anal stenosis: 2 (anoplasty), urogenital sinus: 4 (staged repair), H-type ARM: 8 (staged repair) and persistent cloaca: 3 (staged repair). Primary repair was done in 15 patients (34%), and staged repair was done in 29 patients (65.9%). Anoplasty was done in 9 patients, ASARP (modified tsuchida's procedure) in 8 patients and PSARP in 27 patients. Postoperative complications observed were constipation (n = 21, 47.7%), fecal incontinence (n = 12, 27.27%) with perianal excoriation in 2 patients, anal stenosis (n = 3, 6.8%) and rectal mucosal prolapse (n = 2, 4.5%) CONCLUSION: Delayed presentation of ARMs is not uncommon and is more common in females. Management is almost similar to those who present early. Those who present with chronic constipation and megarectum require staged repair. Complications were more frequent with delayed presentation. Hence, every newborn should have careful examination of perineum and screened for ARM to avoid possible morbidity and mortality.
