High anorectal malformations: surgical repair in neonatal age is better than delayed repair

The malformations of the anorectum are common congenital anomalies. The usual treatment of high anorectal malformations is creating a colostomy at birth, posterior sagittal anorectoplasty [PSARP] at 9-12 months of age and closure of colostomy 4 - 6 weeks later after regular anal dilatation. This 'delayed PSARP' has a number of disadvantages including poor development of normal defecation reflexes. To evaluate continence, cost of management and duration of hospitalization with primary PSARP and to compare it with delayed PSARP. This prospective study was done at the Department of Pediatric Surgery, Children Hospital, Lahore from Nov 1999 to No v 2001. Twenty-four infants [19 boys, 05 girls] with high anorectal malformation were included in the study. All had well developed sacrum and natal cleft, and weighed more than 3 Kg. Twelve patients underwent primary PSARP [Group A] and 12 underwent colostomy, PSARP and then colostomy closure as a three stage procedure [Group B]. The incidence of urinary tract infections [75%], distal loop fecal impaction [41.7%] peri-colostomy skin excoriation [41.7%] was high in Group B as compared to those in Group A. The rate of post PSARP complications and hospital stay was longer in Group B and the average cost including operative procedures, hospital admissions for each complication and follow-up was high [Rs 14,670 +/- 400] in Group B. These results suggest that one stage PSARP is a safe and viable approach to the management of high anorectal malformations in a selected group of neonates

Currarino's syndrome

Currarino's triad is a congenital malformation involving the combination of anorectal stenosis, a presacral mass and an anterior sacral bony defect. A new case is reported in a male neonate, who developed intestinal obstruction on the second day of life. The examination revealed a high anorectal malformation. A colostomy was performed. Partial agenesis of the sacrum was diagnosed radiologically. Computed tomographic myelography demonstated an anterior sacral meningocele and a tethered spinal cord. Excision of the meningocele and untethering of a tethered spinal cord were performed. Secondly, posterior sagittal anorectoplasty was performed. Colostomy was closed 3 months after rectal dilatations. Early diagnosis and management is recommended to avoid the high mortality and morbidity associated with this condition

experience with rectal duplications and review of literature

We are reporting eight cases of rectal duplications over a period of 11 years from 1989 to year 2000. Three of these cases were associated with colonic duplications and were of tubular variety whereas rests were cystic. Presentation of each was completely different. Mode of presentation, methods of diagnosis and management strategies are discussed along with the review of literature

Posterior sagittal anorectoplasty: an approach for the treatment of anorectal malformations

Posterior sagittal anorectoplasty [PSARP] is a new approach for the treatment of anorectal malformations. It provides excellent exposure of the anatomy of these defects and of the important structures of the pelvis as well. This work includes 11 cases of anorectal malformations managed at the Casualty and the Pediatric Surgical Departments, Faculty of Medicine, Cairo University during the period from November 1987 to May 1989. Seven cases were of the high anomaly: 4 males and 3 females, and 4 cases with questionable clinical evidence. Sigmoid defunctioning colostomy preceded all cases except those with low malformations. All cases were corrected by PSARP: full, limited or minimal. All cases were instructed to follow a protocol of post- operative anal dilatations for a variable period of time. Results were satisfactory in 9 cases; 2 cases with abnormal sacrum are expected to show unsatisfactory continence