1. Delayed presentation of anorectal malformations in a tertiary care hospital in India
- Author
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Arnab Kumar Saha, Pinaki R. Debnath, Rashmi Dotikalkar, Sarita Syal, Anil Kumar Garbhapu, Atul Kumar Meena, Vijay Kumar Kundal, Shalu Shah, Gali Divya, Amita Sen, Rajasekhar Addagatla, Chetna Khanna, and Vasu Gautam
- Subjects
Male ,medicine.medical_specialty ,Constipation ,Urinary Fistula ,Fistula ,Anal Canal ,Comorbidity ,Perineum ,Tertiary Care Centers ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Anal stenosis ,030225 pediatrics ,Pediatric surgery ,medicine ,Humans ,Rectal Fistula ,Fecal incontinence ,Child ,Digestive System Surgical Procedures ,Retrospective Studies ,Chronic constipation ,business.industry ,Megarectum ,Infant, Newborn ,Rectum ,Infant ,General Medicine ,medicine.disease ,Anorectal Malformations ,Surgery ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Digestive System Abnormalities ,Fecal Incontinence - Abstract
To study delayed presentation of ARMs, management and its effect on surgical and functional complications.It is a retrospective study from March 2015 to March 2020. All the patients satisfying the criteria of delayed ARMs, i.e., presenting 7 days after birth were included. Information regarding type of ARM, mode of presentation, time of presentation, associated anomalies, management strategy, postoperative complications and functional outcome was noted. Minimum follow-up period was 6 months.Out of 102 patients with ARM, 44 patients presented late. Among the 44 patients, 9 were males and 35 were females. Associated comorbidities observed are low birth weight (n = 9) and preterm (n = 13). Associated anomalies observed were cardiac (n = 18), renal (n = 8), other gastrointestinal (n = 5) and skeletal (n = 1). (1) Male: rectourethral fistula-2 (staged repair), anal stenosis-3 (anoplasty) and anocutaneous fistula-4 (anoplasty). (2) Female: vestibular fistula: 15 (6 primary definitive surgery + 9 staged repair), ectopic anus: 3 (staged repair), anal stenosis: 2 (anoplasty), urogenital sinus: 4 (staged repair), H-type ARM: 8 (staged repair) and persistent cloaca: 3 (staged repair). Primary repair was done in 15 patients (34%), and staged repair was done in 29 patients (65.9%). Anoplasty was done in 9 patients, ASARP (modified tsuchida's procedure) in 8 patients and PSARP in 27 patients. Postoperative complications observed were constipation (n = 21, 47.7%), fecal incontinence (n = 12, 27.27%) with perianal excoriation in 2 patients, anal stenosis (n = 3, 6.8%) and rectal mucosal prolapse (n = 2, 4.5%) CONCLUSION: Delayed presentation of ARMs is not uncommon and is more common in females. Management is almost similar to those who present early. Those who present with chronic constipation and megarectum require staged repair. Complications were more frequent with delayed presentation. Hence, every newborn should have careful examination of perineum and screened for ARM to avoid possible morbidity and mortality.
- Published
- 2021
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