Delayed presentation of anorectal malformation for definitive surgery
Pediatric Surgery International, 08/01/2012
Sharma S et al. – Delayed presentation of anorectal malformations (ARM) especially in girls is quite common in developing countries. With proper perioperative care, these cases may be managed successfully with a single stage procedure in most cases. The mature tissue growth with age allows proper tissue dissection and good repair of the perineal body in girls.Methods
- Patients with ARM presenting beyond 5 months of age managed from January 2008 to March 2012 were studied for clinical outcome.
- Ages at presentation varied from 5 months to 14 years, seven patients were older than 5 years of age.
- Of the 36 cases, 5 patients (3 boys and 2 girls) had presented with colostomy done elsewhere.
- Four patients had high anomalies. Of the 33 girls, 14 had rectovestibular fistula and 9 had anovestibular fistula. Bowel preparation with peglec was used in patients without colostomy.
- Preoperative retention enemas, laxatives and Hegar dilators were used for 3–11 days before surgery.
- On table irrigation was required in four. Patients without a covering colostomy were kept nil per oral for 5 days following surgery in prone/lateral position.
- Two patients had mild post-op wound infection, and were managed with local care.