Delayed presentation of anorectal malformations

Abstract

Aims and Objectives:Delayed management of anorectal malformation (ARM) increases the surgical and functional complications for the patient. We defined “delayed presentation of ARM” and reviewed our patients with ARM to find out the incidence and causes of delayed presentation.Materials and Methods:Patients satisfying the criteria of “delayed presentation of ARM” were involved. Detailed information of each patient including the mode of presentation, associated anomalies, plan of management and follow-up was obtained from the hospital records.Results:Between 2003 and 2006, 43 patients satisfied our criteria of “delayed presentation of ARM”. There were 21 males and 22 females. Seventeen of these males presented with low-type ARM. Eleven of them were managed by a single-stage procedure. These “delayed presenters” had to live with constipation, inadequate weight gain and parental anxiety for a greater time. Analysis of the outcomes showed more functional complications in patients who had undergone failed perineal surgery previously. In females with low ARM, the procedure of choice was anterior sagittal anorectoplasty (ASARP). Single stage surgery provides good outcomes for most of low type of ARMs. High-type ARMs in males and females were managed by a staged procedure.Conclusion:“Delayed presentation of ARM” is a major group of ARM in our setup. The management and results of their treatment are not different from those of the early presenters. The most common cause of delayed ARM is wrong advice given by the health care providers followed by inadequate treatment elsewhere. Corrective surgeries taking second attempt in perineum always produces poor outcomes.

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

“…The more benign forms of ARMs are the ones most commonly missed. The incidence in this report is similar to previously published figures, at 27 % [26]. A study done in Malawi cited various possible reasons for delayed ARM diagnoses in that country, including a high proportion of home deliveries with a traditional birth attendant, distance needed to travel to definitive care settings and lack of health care workers [25].…”

“…The Italians patient sample displayed more of an equivalent male to female ratio, whereas the South African sample displayed more of a male predominance, which is similar to the literature published in both cases [2,24]. The African statistic may be biased, as female ARM diagnoses may be more easily missed at birth without expert examination [25][26][27]. Of statistical significance additionally was a higher maternal age in the Italian sample (38 years old vs the South African 28 years old).…”

“…For babies that were born outside a medical facility, a delayed diagnosis was made if the neonate presented more than 48 h postpartum. A delay in diagnosis seems to be a common factor in the African setting, but not exclusive to it as can be seen in studies conducted in India, Ireland, Serbia and even Australia [26,27,31,32]. The more benign forms of ARMs are the ones most commonly missed.…”

“…A study done in Malawi cited various possible reasons for delayed ARM diagnoses in that country, including a high proportion of home deliveries with a traditional birth attendant, distance needed to travel to definitive care settings and lack of health care workers [25]. Some presentations are more subtle at birth, thus diagnosis by insufficiently trained and skilled doctors or nurses may contribute to the diagnosis delay [25,26,31]. Delayed diagnoses lead to increased morbidity and mortality in these patients, as well as causing significant parental anxiety.…”

Female ARM Left to Loiter: Attempt for Delayed Primary PSARP with Meticulous Outcome

“…In view of sub acute presentation, poor socio economic condition and lack of access to advanced medical care, many cases of female ARM present at a later age group [5]. Fecal incontinence is reported in almost 30-50 % of the adolescent patients after surgery [6].…”