Anorectal malformations presenting with colorectal perforation: Frequency, associated morbidity and mortality

Abstract

Aim Colorectal perforations (CRP) in patients with anorectal malformations (ARM) are infrequently encountered because of their early diagnosis and treatment. Despite recently‐improved neonatal management; CRP during the neonatal period is still a major problem for paediatric surgeons. The aim of the present study was to evaluate the frequency of bowel perforation with ARM in our locality, and the associated morbidity and mortality. Patients and Methods During May 2002 and April 2012, a prospective study was conducted on 416 neonates suffering from ARM (277 high ARM, and 138 low ARM), who presented to Assiut University Children Hospital. The inclusion criteria were all neonates with CRP only related to acute obstruction caused by ARM. Results Only seven cases fulfilled the inclusion criteria. Their age at presentation ranged from 3 days to 14 days. Five neonates had high ARM, while two had low ARM. The diagnosis of bowel perforation was suspected preoperatively in four cases, and was accidentally discovered either intraoperatively in two cases with high ARM or after the anoplasty for low ARM. Two mortalities were encountered; both had a complicated postoperative course with postoperative sepsis and disseminated intravascular coagulation. Conclusions Although rare, colorectal perforation in ARM should always be suspected in delayed ARM presenters. Close postoperative observation is very important to detect any late postoperative perforation.

Anorectal malformations: Early outcome analysis in a tertiary care center in India

“…Delay in the presentation of patients with ARM leads to the progression of neonatal intestinal obstruction, sepsis, aspiration pneumonia, intestinal perforation, and sometimes death. [14][15][16][17][18] Delayed presentation is common among female neonates because there is still some decompression through the vestibular fistula in most instances, unlike in males where abdominal distension occurs over a few days in most patients with a recto-urethral fistula. [19,20] Urosepsis with septicemia is also more likely in males.…”

Delayed diagnosis of anorectal malformations in neonates

“…The rate of significant morbidity directly related to perforation in ARM may be as high as 57% . Mortality among patients who suffer intestinal perforation may reach 50%, particularly in neonates who are premature or have associated anomalies …”

“…Spontaneous intestinal perforation in ARM is a rare and highly morbid event, and a delay in ARM diagnosis is considered to increase the risk of this complication . Previous studies report an increased incidence of intestinal perforation in the setting of delayed ARM diagnosis, ranging from 3% to 9.6%.…”

“…The proposed aetiology for perforation in cases of ARM is distal occlusion, resulting in distension and ischaemia, progressing to gangrene and perforation . The rate of significant morbidity directly related to perforation in ARM may be as high as 57% .…”

Missed or delayed diagnosis of anorectal malformations: a review of the literature, current training and practice in the UK in relation to detection via the NIPE programme

“…Affecting both males and females, these anomalies vary in their appearance and presentation, lack features enabling antenatal detection and should be detected at birth by the examining midwife3 or within 72 hours through the newborn and infant physical examination (NIPE) screening programme. It is recognised that the diagnosis of ARMs can be missed or delayed leading to morbidity and mortality 4–18…”