Management Of Absent Anal Opening In Child!

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By Dr. Rishavdeb Patra, Pediatric Surgery

The Anorectal Malformation, also known as the imperforate anus, is a birth defect that causes problems including:

  • Absence of an anal opening.
  • Abnormal position of the anal opening (or usually very small opening).
  • Fistula (Abnormal opening or connection) between the rectum and bladder, urethra, or vagina.
  • Cloaca, in which the rectum, vagina, and urethra of girl child join together.

According to the estimation of the Cincinnati Children’s Hospital, approximately one in every 5,000 babies has an imperforate anus or other Anorectal Malformation. This is more common in boys as compared to girls.  It is a type of spectrum defect of anus and rectum, which occur during the development of the baby in the womb (usually during the fifth to seventh week of the pregnancy). With this abnormality, the rectum and anus are not properly developed.

Causes:

When the fetus is in the womb, there are several organs developing and maturing to form an organ system. The lower part of the intestinal tract develops early (usually in the first 2- 3 months). During this period, certain steps are required for the anus and rectum to properly develop. In some cases, these steps do not occur, which should happen and cause the Anorectal Malformation.

Symptoms:

  • Lack of stool due to absent anal opening
  • Urine coming out from the anus
  • Stool coming out from the vagina
  • Difficulty in having a bowel movement
  • Constipation

Management of Anorectal Malformation-

There are many treatment options available. However, it totally depends upon age, symptoms, overall health of the child, and severity of the condition. In most of the cases, the child needs to undergo the surgical procedure to treat the problem. However, the type of surgery will vary and depends upon the severity and symptoms of the child.

Some surgeries include:

  • Colostomy: In this type of surgical procedure, the ends of the large intestine are brought through an opening made in the abdominal wall. The upper stoma makes it possible to pass the stool through this opening. The lower stoma enables to pass the mucus.
  • Connecting the Rectum to the Anus: In this type of surgery i.e. Anorectoplasty, the rectum is pulled through and sutured to the new anal opening made in the normal position. Once the surgery is done the colostomy is closed after 3 to 6 months.

Take Away Message:

The Anorectal Malformation is a birth defect and most of the children need surgery to treat this problem. However, it is always advised to consult an experienced and specialized Pediatric Surgeon for this purpose. A proper consultation will help you to choose the best option that suits you.



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