CLINICAL STUDY OF ANORECTAL MALFORMATIONS

BACKGROUND: Anorectal malformations are relatively encountered anomalies. Presentations may vary from mild to severe and bowel control is the main concern. AIM: To study the modes of presentation, types of anomalies, associated anomalies, reliability of clinical signs and radiological investigations in the diagnosis and the prognosis and continence in the post-operative in relation to type of anomaly and associated anomaly (s). MATERIAL AND METHODS: 50 cases of anorectal malformations admitted to Department of Paediatric Surgery, in Medical College and Research Institute, were included in the study. Data related to the objectives of the study were collected. RESULTS: Commonest mode of presentation was failure to pass meconium 50%. 59% of males had high anomalies, while 53% females had intermediate anomalies. The diagnosis of low anomaly was made clinically, while high and intermediate anomalies needed further investigations. Associated anomalies were noted in 46.6% of the cases. 71.42% of these patients had either a high or intermediate ARM. All patients with high anomalies underwent a 3 stage procedure, while low anomalies underwent a single stage procedure followed by anal dilatations. Rectal mucosal prolapse (2 cases), wound infection (4 cases), stenosis (3 cases), retraction of neo anus (1 case) was seen. All the patients with low anomalies had a good functional result post operatively, while 57% and 28% of patients with intermediate and high anomalies had good results. CONCLUSION: Anorectal malformations are common congenital anomalies. Males are more commonly affected (1.3:1). Low anomalies are the commonest lesions noted in both the sexes (36.67%). High anomalies are more frequent in males. Invertogram offer an accurate diagnosis for planning management in patients with anorectal malformations. Low anomalies have a better outcome following surgery. For intermediate and high anomalies a staged repair offers better results. The situation would improve further if MRI Imaging is more readily available and these children are brought for appropriate treatment at the earliest.