Imperforate Anus

Imperforate Anus

Imperforate Anus

Imperforate Anus

Is a congenital malformation in which the rectum has no outside opening.

Aetiology:

Abnormal embryological development of the anus " 8th wks. "

Cause:

Unknown ( associated with other congenital anomalies).

Types:

1- low imperforate anus: the rectum has descended below the pubococcygeal line ( puborectalis muscle), the internal and external sphincters are present and well developed with normal function and there is no connection with the genitourinary tract.

2- High Imperforated Anus: the rectum ends above the puborectalis muscle. this is usually associated with genitourinary tract ( fistula ) rectourethral (male), or rectovaginal ( female).

Complications:

Rectal stenosis.

Separation of the anastomosis.

Ureteral injury.

UTI.

Rectal fistulas.

Clinical manifestations:

- Is usually discovered immediately after birth ( within several hours).

- No anal opening.

- Thermometer can't be inserted into the rectum.

- The absence of meconium.

- Green-tinged urine, ( if fistula present).

- Progressive abdominal distention.

Diagnostic evaluation:

- Visual examination.

- General examination for associated anomalies.

- Urine examination ( stool in urine ).

- Sonography.

- Wangensteen-Rice X-ray: ( upside down position ), useful after 24hrs.

Treatment:

- Low: decompression of bowel, dilation of fistula, then definitive repair by angioplasty.

- High: colostomy for decompression, then definitive repair by pull-through surgery when infant one year or about 10 kg weight).

Pre-op and post-op care:
- high risk for injury related to the inability to evacuate rectum, surgery.

- Altered nutrition ( less than body requirements ) related to the inability to feed.

- Altered family processes related to the care of a child with a physical defect, hospitalization.



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