Imperforate Anus Types, Complications, Treatment
Imperforate Anus: Is a congenital malformation in which the rectum has no outside opening.Imperforate Anus
Abnormal embryological development of the anus ” 8th wks. “
Unknown ( associated with other congenital anomalies).
1- low imperforate anus: the rectum has descended below the pubococcygeal line ( puborectalis muscle), the internal and external sphincters are present and well developed with normal function and there is no connection with the genitourinary tract.
2- High Imperforated Anus: the rectum ends above the puborectalis muscle. this is usually associated with genitourinary tract ( fistula ) rectourethral (male), or rectovaginal ( female).
Separation of the anastomosis.
– Is usually discovered immediately after birth ( within several hours).
– No anal opening.
– Thermometer can’t be inserted into the rectum.
– The absence of meconium.
– Green-tinged urine, ( if fistula present).
– Progressive abdominal distention.
– Visual examination.
– General examination for associated anomalies.
– Urine examination ( stool in urine ).
– Wangensteen-Rice X-ray: ( upside down position ), useful after 24hrs.
– Low: decompression of bowel, dilation of fistula, then definitive repair by angioplasty.
– High: colostomy for decompression, then definitive repair by pull-through surgery when infant one year or about 10 kg weight).
Pre-op and post-op care:
– high risk for injury related to the inability to evacuate rectum, surgery.
– Altered nutrition ( less than body requirements ) related to the inability to feed.
– Altered family processes related to the care of a child with a physical defect, hospitalization.