Management of Anorectal Malformation: Experience from Ethiopia

Abstract

Background: Anorectal malformations are among the most common congenital malformation seen in children. There is paucity of data regarding the incidence and treatment outcome of this disease from Ethiopia. Methods: This is a retrospective review of patients treated for ARM at the TASH from March 2010-February 2014. Relevant statistical analysis was done and the results presented in tables and graphs. Results: Six patients (6%) presented at early neonatal age (before the age of 4 days) and 14 (14%) presented between 4 days and one month. A total of 57 associated congenital malformations were diagnosed in 44/99(44%) patients. The two most common type of ARM diagnosed among the female patients were rectovestibular fistula which occurred in 39/56 (70%) and

Overview of Anorectal Malformations in Africa

“…There is a slight to moderate male preponderance in cases of ARM ranging from 55 to 71% according to majority of reports ( 8 – 14 ) but a few had shown the reverse ( 15 – 18 ), which could be due to loss of male neonates from delay in seeking care in the catchment areas of the hospitals concerned. Rectovestibular fistula is the predominant type of ARM seen in females representing 70–78% of the malformations in girls ( 8 , 14 , 17 , 19 – 21 ).…”

“…Imperforate anus without fistula was the predominant type seen in 31–42% of boys with ARM in Kenya ( 14 , 22 ). On the other hand, ARM with rectourethral fistula predominates in boys in Nigeria ( 9 ), Cape Town in South Africa ( 20 ), Ethiopia ( 17 ), Uganda ( 21 ), and in Malawi ( 23 ). A major limitation encountered in comparing the spectrum of malformations in various publications is the use of different and inconsistent classification schemes by various authors.…”

“…The presence of associated malformations in other systems is seen in 9–44% of patients in various series across the continent ( 9 , 12 , 15 , 17 – 19 , 26 ). Those figures are lower than the expected and more widely documented proportion of 50–78% ( 27 – 30 ) of patients with ARM who have associated malformations.…”

“…Delay in presentation of patients with ARM leads to progression of neonatal intestinal obstruction ( Figures 1 , 2 ), sepsis, aspiration pneumonia, intestinal perforation, and sometimes death ( 13 , 17 , 37 – 39 ). Adejuyigbe et al ( 9 ) in a retrospective review of 86 patients managed on account of ARM at Ile Ife, Nigeria reported that 74 (86.0%) presented after 24 h of birth.…”

Accuracy of Lateral Invertogram in diagnosing and classifying anorectal malformations

“…MRI can accurately detect the level of the terminal bowel and the state of the pelvic floor musculature, and also, can demonstrate the presence of a fistula. [23] The surgical management of an infant with anorectal malformation depends on the level of the anomaly as well as the presence or absence of a fistula between the rectal pouch and adjacent organs and other coexisting congenital malformations. Newborn primary anoplasty is the surgical method of choice for low-lying anomalies, while temporary colostomy is usually chosen for high-lying anomalies.…”