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

Authors

  • Priya Mathew SMS Medical College, Jaipur, Rajasthan, India
  • Arun Kumar Gupta Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Rahul Gupta Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Dharmesh Sharma Department of Preventive and Social Medicine, SMS Medical College, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.47338/jns.v10.927

Keywords:

Anorectal malformation, Associated anomalies, Colostomy, Mortality, Neonates, Outcomes

Abstract

Background: Delayed diagnosis, referral, and presence of associated anomalies may influence the outcome of Anorectal malformations (ARM). The aim of this study was to analyze the early outcomes (1 month postoperatively) of ARM presenting in the neonatal period.

Methods: A prospective study was carried out in our tertiary care teaching institute from December 2018 to March 2020. All neonates admitted in the NICU with ARM were studied.

Results: There were 315 neonates; out of these, 236 (74.92%) were male and 79 (25.07%) were female. High ARM (HARM) was present in 265 (84.13%) and low ARM (LARM) in 50 (15.87%). Associated congenital anomalies were noted in 121 (38.41%). Major associated anomalies consisted of gastrointestinal (GIT) (41.32%), oesophageal (31.4%), and genitourinary (GU) (19.83%). Out of 306 procedures for ARM, 196 (64.05%) neonates underwent left transverse colostomy (LTC). The most frequent postoperative complications were thrombocytopenia (115) followed by sepsis (98). Colostomy prolapse was uncommon (2). The overall mortality was 87/315 (27.61%) neonates - 82/265 (30.94%) in HARM and 5/50 (10%) in LARM. Neonatal mortality was significantly high with birth weight <2500gm 55/153 (35.94%; p value= 0.0001), associated malformations 82 (67.76%, p value= 0.003); and delayed presentation 40/87 (45%), and with primary perforation 5/6 (83.33%).

Conclusions:  Higher mortality was associated with low birth weight, double/ triple atresia, neonatal GIT perforation, sepsis on admission, and those with oesophageal and cardiac anomalies. More than 1/3rd (38.41%) patients had associated anomalies; thus, a detailed systematic evaluation of all subtypes is paramount.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Priya Mathew, SMS Medical College, Jaipur, Rajasthan, India

Department of Pediatric Surgery,

Arun Kumar Gupta, Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Senior Professor,

Rahul Gupta, Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Associate Professor,

Dharmesh Sharma, Department of Preventive and Social Medicine, SMS Medical College, Jaipur, Rajasthan, India

Associate Professor,

References

Levitt MA, Pena A. Anorectal malformations. Orphanet J Rare Dis. 2007; 2:33.

Wood RJ, Levitt MA. Anorectal malformations. Clin Colon Rectal Surg. 2018; 31:61-70.

Bechit E, Murphy F, Puri P, Hutson JM. The clinical features and diagnostic guidelines for identification of anorectal malformations, In: Anorectal Malformations in Children. Springer Berlin Heidelberg; 2006 .p. 185-200.

Nah SA, Ong CC, Lakshmi NK, Yap TL, Jacobsen AS, Low Y. Anomalies associated with anorectal malformations according to the Krickenbeck anatomic classification. J Pediatr Surg. 2012; 47:2273-8.

Stoll C, Alembik Y, Dott B, Roth MP. Associated malformations in patients with anorectal anomalies. Eur J Med Genet. 2007; 50:281–90.

Pierro A, Eaton S, Ong E. Neonatal physiology and metabolic considerations. In: Grosfeld JL, O’Neill JA Jr, Coran AG, Fonkalsrud EW, Caldamone AA. editors. Pediatric Surgery. 6th ed. Chicago: YearBook; 2006. p. 89-113.

Thapa B, Basnet B, Pun M, Thapa A. Management of Anorectal malformations in a tertiary level children’s hospital of Nepal. J Nepal Paediatr Soc. 2013; 33:196-200.

Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A, et al. Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg. 2005; 40:1521-6.

Solomon BD. VACTERL/VATER association. Orphanet J Rare Dis. 2011; 6:56.

Spitz L. Oesophageal atresia. Orphanet J Rare Dis. 2007; 2:24.

Mirshemirani A, Ghorobi J, Roozroukh M, Sadeghiyan S, Kouranloo J. Association between urogenital and anorectal malformations. Iran J Pediatr. 2008; 18:171-4.

Horsirimanont S, Sangkhathat S, Utamakul P, Chetphaopan J, Patrapinyokul S. An appraisal of invertograms and distal colostogram in the management of anorectal malformations. J Med Assoc Thai. 2004; 87:497-502.

Goossens WJ, de Blaauw I, Wijnen MH, de Gier RP, Kortmann B, Feitz WF. Urological anomalies in anorectal malformations in the Netherlands: Effects of screening all patients on long-term outcome. Pediatr Surg Int. 2011; 27:1091-7.

Lukong CS, Ameh EA, Mshelbwala PM, Jabo BA, Gomna A, Akiniyi OT, et al. Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria. Afr J Paediatr Surg. 2011; 8:19-22.

Gama M, Tadesse A. Management of anorectal malformation: experience from Ethiopia. Ann Afr Surg. 2018; 15:25-8.

Tong WD, Ludwig KA. Neonatal colon perforation due to anorectal malformations: can it be avoided? World J Gastroenterol. 2013; 19:3915-7.

Eltayeb AA. Anorectal malformations presenting with colorectal perforation: frequency, associated morbidity and mortality. Surg Prac. 2014; 18:23–6.

Olatunji T, Igoche M, Anyanwu P, Ameh EA. Spontaneous ileal perforation complicating low anorectal malformation. Afr J Paediatr Surg. 2015; 12:152-4.

Eltayeb AA. Delayed presentation of anorectal malformations: the possible associated morbidity and mortality. Pediatr Surg Int. 2010; 26:801–6.

Poenaru D, Borgstein E, Numanoglu A, Azzie G. Caring for children with colorectal disease in the context of limited resources. Semin Pediatr Surg. 2010; 19:118–27.

Beudeker N, Broadis E, Borgstein E, Heij HA. The hidden mortality of imperforate anus. Afr J Paediatr Surg. 2013; 10:302-6.

Vilanova CS, Hirakata VN, de Souza Buriol VC, Nunes M, Goldani MZ, da Silva CH. The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Popul Health Metrics. 2019; 17:15.

Bischoff A, DeFoor W, VanderBrink B, Goebel J, Hall J, Alonso M, et al. End stage renal disease and kidney transplant in patients with anorectal malformation: is there an alternative route? Pediatr Surg Int. 2015; 31:725-8.

Chadha R, Khan NA. Congenital pouch colon. J Indian Assoc Pediatr Surg. 2017; 22:69-78.

Saxena AK, Mathur P. Classification of congenital pouch colon based on anatomic morphology. Int J Colorectal Dis. 2008; 23:635–9.

Gupta R, Sharma P, Chatterjee A, Shukla AK, Gupta AK, Agrawal LD, et al. Congenital pouch colon with segmental dilatation of ileum: Congenital pouch colon type 6. J Indian Assoc Pediatr Surg. 2020; 25:319-22.

Bhatnagar S. Anorectal malformations (part 1). J Neonatal Surg. 2015; 4:7.

Menon P, Rao KLN, Sinha AK, Lokesha K, Samujh R, Mahajan JK, et al. Anorectal malformations in males: Pros and cons of neonatal versus staged reconstruction for high and intermediate varieties. J Indian Assoc Pediatr Surg. 2017; 22:83-6.

Mathur P, Saxena AK, Bajaj M, Chandra T, Sharma NC, Simlot A, et al. Role of plain abdominal radiographs in predicting type of congenital pouch colon. Pediatr Radiol. 2010; 40:1603–8.

Gupta R, Gupta AK, Shukla AK, Chaturvedi V, Sharma P, Tanger R. Anorectal malformations: Early outcome analysis from a high-volume tertiary care institute. Med J DY Patil Vidyapeeth. 2019; 12:122-30.

Sabzehei MK, Mousavi-Bahar SH, Bazmamoun H. Urogenital and other associated anomalies patients with anorectal malformations. Nephro-Urol Mon. 2012; 4:388-90.

O'Neil J, Grosfeld J, Fonkalsrud E. Anorectal disorders and imperforated anus. In: Principles of Pediatric Surgery. 2nd ed. New York: Mosby; 2004. p. 596.

Kamal JS, Azhar AS. Congenital cardiac anomalies and imperforate anus: A hospital's experience. J Cardiovasc Dis Res. 2013; 4:34-6.

Van den Hondel D, Sloots C, Meeussen C, Wijnen R. To split or not to split: Colostomy complications for anorectal malformations or Hirschsprung disease: A single centre experience and a systematic review of the literature. Eur J Pediatr Surg. 2014; 24:61-9.

Gupta R, Sharma P, Goyal RB. Kluth type IIIb6 esophageal atresia: Diagnostic dilemma and pitfalls of using infant feeding tube. J Indian Assoc Pediatr Surg. 2018; 23:96-9.

Gupta R. Esophageal atresia: Early outcome analysis from a high-volume tertiary care institute in India. Saudi J Health Sci. 2018; 7:14-22.

Gupta R, Sharma SB, Dagla R. Nonfluoroscopic well-tempered pressure augmented distal colostogram in high-type anorectal malformation: Our experience. Arch Int Surg. 2015; 5:88-95.

Patwardhan N, Kiely EM, Drake DP, Spitz L, Pierro A. Colostomy for anorectal anomalies: High incidence of complications. J Pediatr Surg. 2001; 36:795-8.

Pena A, Migotto-Krieger M, Levitt MA. Colostomy in anorectal malformations: A procedure with serious but preventable complications. J Pediatr Surg. 2006; 41:748-56.

Gubbi S, Gupta R, Gupta AK, Shukla AK. Left transverse loop colostomy versus high sigmoid loop colostomy for high-type anorectal malformations: Early outcome analysis. J NTR Univ Health Sci. 2018; 7:249-53.

Gangopadhyay AN, Pandey V. Anorectal malformations. J Indian Assoc Pediatr Surg. 2015; 20:10-5.

Mathur P, Saxena AK, Simlot A. Management of congenital pouch colon based on the Saxena-Mathur classification. J Pediatr Surg. 2009; 44:962–6.

Published

2021-05-11

How to Cite

1.
Mathew P, Gupta AK, Gupta R, Sharma D. Anorectal malformations: Early outcome analysis in a tertiary care center in India. J Neonatal Surg [Internet]. 2021May11 [cited 2021Jun.13];10:22. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/927

Issue

Section

Original Article

Most read articles by the same author(s)

1 2 3 > >>