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[Anorectal malformations: a 6-years review at the University Clinics of Lubumbashi]
Trésor Kibangula Kasanga1, Didier Tshibangu Mujinga1, Florent Tshibwid Zeng2
1Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo.
Insights
Anorectal malformations (ARM) are common in infants, often diagnosed late via intestinal obstruction. Early detection and consistent follow-up are crucial for improving outcomes and reducing mortality in these congenital anomalies.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Neonatal Care
Background:
- Anorectal malformations (ARM) encompass a spectrum of congenital anomalies affecting the genitourinary and anal structures.
- Early diagnosis of ARM is critical for effective management and reducing associated mortality, particularly in resource-limited settings.
Observation:
- A prospective study included 24 infants (median age 2 days) with ARM.
- Intestinal obstruction was the most common diagnostic presentation (50%).
- Low ARM, often without fistula, was frequent (45.7%), with intestinal atresia as the most common associated anomaly.
Findings:
- Anoplasty was performed in 54.1% of patients.
- Mortality was 25% (6/24), with 25% lost to follow-up.
- Among reviewed patients, 75% (9/12) achieved fecal continence, predominantly those with low ARM.
Implications:
- ARM diagnosis frequently occurs late, during intestinal obstruction, highlighting a need for improved early detection strategies.
- High mortality and loss to follow-up underscore the necessity for enhanced long-term patient monitoring and care systems.
- Strategies to improve early diagnosis and ensure consistent follow-up are vital for better functional outcomes and reduced mortality in ARM patients.
Abstract:
Anorectal malformations (ARM) are developmental anomalies of the genitor anal elements, they represent a wide range of anomalies. An early diagnosis allows a better management as it reduces mortality associated with ARM, especially in developing countries. A prospective cross-sectional study has been carried, including patients from 0 to one year, admitted in our service for ARM. Twenty-four (24) patients have been considered. The median age was 2 days, the sex ratio 1/3 for female. Intestinal occlusions were the most frequent circumstances of diagnosis (50%), low ARMs were the most frequent, diagnosed in 11 patients (45.7%) of which 10 did not have any fistula. The most common associated malformation was intestinal atresia (3 patients). Anoplasty was done using abdominoperineal pull-through associated to anal dilatations in 13 patients (54.1%). Six patients died from unknown etiology and 6 were lost from the follow-up. Concerning the functional outcome, 12 of the 24 patients concerned by the study attended review and 3 of them presented signs of fecal incontinence, 9 of them were continents among whom 8 were diagnosed low ARM and one with high ARM. ARMs are encountered in our environment, nonetheless, the diagnosis is still made most of the time, during an intestinal occlusion. The mortality rate is still high and measures should be taken to allow long-term reviews, which will surely reduce the number of lost patients.
