Anorectal Malformations: Practical Tips

Abstract

The spectrum of anorectal malformations (ARM) ranges from non-complex low malformation with well developed rectum, anal canal, sphincters and sensory receptors to the complex high malformation with variable development of sphincters and sensory receptors associated with other anomalies. In addition to promptly detect the presence of ARM and associated life threatening defects, the clinician attending the newborn with absence of anal orifice is entrusted with the task of completing the primary evaluation process to decide whether the defect is low which can be corrected with relatively simple procedures like anoplasty or the defect is high necessitating colostomy for relief of obstruction and definitive surgery later. In majority of cases clinical evaluation can establish the working diagnosis to decide the management protocol. In clinically indeterminate cases invertogram can pin point the diagnosis. In cases with doubtful diagnosis, blind perineal exploration is absolutely contraindicated and colostomy is performed leaving the sphincters intact for subsequent work up and definite surgery.