Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences—The ARM-Net Consortium Consensus

Abstract

In the past, an anteriorly located anus was often misdiagnosed and treated as an anorectal malformation (ARM) with a perineal fistula (PF). The paper aims to define the criteria for a normal anus, an anterior anus (AA) as an anatomic variant, and milder types of ARM such as congenital anal stenosis (CAS) and PF. An extensive literature search was performed by a working group of the ARM-Net Consortium concerning the subject “Normal Anus, AA, and mild ARM”. A consensus on definitions, clinical characteristics, diagnostic management, and treatment modalities was established, and a diagnostic algorithm was proposed. The algorithm enables pediatricians, midwives, gynecologists, and surgeons to make a timely correct diagnosis of any abnormally looking anus and initiate further management if needed. Thus, the routine physical inspection of a newborn should include the inspection of the anus and define its position, relation to the external sphincter, and caliber. A correct diagnosis and use of the presented terminology will avoid misclassifications and allow the initiation of correct management. This will provide a reliable comparison of different therapeutic management and outcomes of these patient cohorts in the future.

Prevalence and mortality among children with anorectal malformation: A multi‐country analysis

“…It is suggested that low anomaly forms with a fistula to the perineum of ARM cases are often undiagnosed (Aldeiri et al, 2019; Amerstorfer et al, 2022; Jonker, Trzpis, & PMA, 2017). Our study may have also missed this special cases of ARM that were diagnosed after the surveillance follow‐up ended, especially in programs that could not track birth defects among babies after they were discharged from the maternity hospital.…”

Evaluation of Patients With Congenital Anal Stenosis, Single Center Study

“…Sometimes a membrane near the dentate line may accompany. 2 Diagnosis is mainly clinical. The stenosis observed during the visual examination of the anus may be confirmed by the formula: expected anal caliber (mm) = 1.34 × body weight (kg) + 6.8.…”

“…Pediatric Surgery Clinic, Faculty of Medicine, Yeditepe University, İstanbul, Turkey 2. Pediatrics Clinic, Faculty of Medicine, Yeditepe University, İstanbul, Turkey 3.…”

Anorectal developmental anomalies

“…Перші ознаки захворювання з'являються через 10-12 год після народження: дитина погано спить, напружується; не відходить меконій. Якщо немає кваліфікованого огляду, то через одну добу з'являється здуття живота, блювота спочатку шлунковим вмістом, а потім з домішками жовчі і кишкового вмісту [9]. Дитина відмовляється від грудей.…”

“…Необхідні подальші багатоцентрові дослідження або дослідження на основі реєстру, щоб з'ясувати роль прийому матір'ю медичних препаратів у розвитку АВР. Martynov, et al [9] провели бібліометричний аналіз оригінальних наукових статей про АВР, який важливий для клініцистів і науковців, щоб зрозуміти глобальну дослідницьку діяльність на цю тему.…”