Experience with anorectal malformations in Ile-Ife, Nigeria

Abstract

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.

Spectrum of colorectal surgery operations performed in a single paediatric surgery unit in sub-Saharan Africa

“…This type of surgery, especially in children with long common channels, represents one of the most challenging procedures that paediatric surgeons perform worldwide. [18] Others in the region have reported operating similar number of cases [13][14][15] of such severity. The challenge, however, is that operating on relatively small number of those cases may not allow individual surgeons to have adequate expertise that exposure to multiple cases of cloacal malformations or cloacal exstrophy will provide; hence, it may be worthwhile for centres to continue their efforts at collaboration [19] where surgeons in the sub-region often visit other centres when they have such cases and there may be a need to identify hospitals with greater resources to manage complex colorectal problems in children.…”

“…Delayed presentation is typical as reported from different centres in Nigeria. [13][14][15] The delay in presentation is often due to socioeconomic challenges, distance between place of residence and urban centres where paediatric surgical units are located [16] and poor awareness by mothers, [17] and perhaps health care workers [13] about the different spectrum of colorectal pathologies. The patients with HD particularly presented much later than those with anorectal malformations with only 18% of the patients operated on account of HD presenting with symptoms suggestive of the disease in the first 28 days of life.…”

Anomalia anorretal e cuidados maternos

“…A imperfuração anal é uma das anomalias anorretais e está associadas aos defeitos em outros sistemas do corpo (3,8) , e estudos mostram a associação mais frequente com o trato urogenital (9)(10)(11)(12)(13)(14) ; a sobrevida depende da severidade das anomalias associadas. Logo no início deve-se obter uma anamnese sistemática e iniciar o tratamento, cirúrgico ou clínico, o mais precoce possível, a lesão se desenvolve devido à falta de complementação do complexo embriológico (15)(16)(17)(18)(19) . O tratamento cirúrgico convencional é a confecção da colostomia pélvico proximal (20)(21) , em neonatos com um dia de vida, seguindo a formação da fístula com a realização da anorretoplastia sagital posterior, realizada aos 4 ou 6 meses de vida (22)(23) .…”

Preventing posterior sagittal anoplasty ′cripples′ in areas with limited medical resources: A few modifications to surgical approach in anorectal malformations

“…Mortality related to ARM is still high in Africa (30.5%) because most patients are referred late for medical attention. Adejuyigbe et al, [4] reports that only 15% are observed within 24 hours of life. Male infants present vomiting and progressive abdominal distension and are destined to die whenever colostomy is not performed on emergency basis.…”