Anorectal malformations in adolescent females: A retrospective study

Abstract

Context:While most of the females with anorectal malformations (ARMs) present in either neonatal period or early infancy, a small percentage presents in their adolescence.Aim:The aim is to study the causes of delay in presentation, management, and postoperative outcome in these cases.Settings and Design:This is a retrospective observational study conducted in the Department of Paediatric Surgery, King George's Medical University, Lucknow.Subjects and Methods:Records of females with ARM managed in one unit of the department from 2010 to 2015 were scrutinized. Of these, record of females who primarily presented in adolescence was reviewed. Data regarding the demographics, clinicoradiological presentation, management, postoperative stay, and follow-up were analyzed. Causes for delay in presentation were looked for.Statistical Analysis Used:Statistical analysis used was not required.Results:Out of 627 cases of ARM managed over 5 years, ten girls (5.3%) presented between 12 and 18 years (average 14.4 years). Main reasons for the delay in presentation were misinformation, illiteracy, and poverty. These comprised of anovestibular fistula (n = 5), anterior ectopic anus (n = 3), perineal canal (n = 1), and rectovestibular fistula (n = 1). Three (30%) girls had no problem apart from an abnormal anal orifice. Five (50%) girls had constipation as a major additional symptom. Four cases had a normal to mildly enlarged rectum on contrast study, whereas the rectum was moderately to hugely dilated in the remaining six cases. Six cases were managed with posterior sagittal anorectoplasty while an anterior sagittal anorectoplasty was done in four. Minor wound dehiscence developed in two cases. There was no mortality. In a mean follow-up of 16 months (8–26), constipation and soiling were seen in 5 (50%) girls. The overall outcome in these girls was satisfactory.Conclusion:Presentation of females with ARM in adolescence is not uncommon in the third world. A primary pull through is possible in these girls with mild-to-moderate rectal dilatations. A diverting colostomy before pull through is always a safe option in cases with severely dilated rectum and also otherwise. Moreover, a greater awareness regarding these malformations in the general public is required.

Malformation anorectale avec fistule recto-uretro-bulbaire prise en charge tardivement: à propos d'un cas

“…Le médecin remarque un anus non-ouvert ou placé anormalement. Dans les pays en développement, les principales raisons du retard de diagnostic sont le faible niveau intellectuel, la désinformation et la pauvreté [13]. Le retard de prise en charge de notre patient (10 mois de vie), illustre encore mieux le challenge que représente la prise en charge des MAR dans les milieux à faibles revenus.…”

“…Dans ces pays en développement, le retard de diagnostic et le manque de chirurgiens pédiatres rendent complexe la prise en charge des MAR [14]. La PEC chirurgicale peut être réalisée avec ou sans colostomie préalable, selon la présence ou non d'une fistule périnéale ou vestibulaire, ou encore la présence ou pas d'une constipation chronique, dans les présentations tardives [11,13]. Elle consiste en une anorectoplastie sagittale, laquelle peut être faite par voie postérieure (la technique la plus utilisée actuellement) ou antérieure.…”

“…Cette prise en charge doit se faire en période néonatale car d'elle dépend le devenir immédiat du nouveau-né [12]. Cependant, des cas de prise en charge tardive ont été rapportés et ce, essentiellement dans les pays en développement [13,14]. Cet article présent un cas rare des malformations anorectales (imperforation anale avec fistule recto-uretrobulbaire prise en charge tardivement chez un nourrisson.…”