Imperforate Anus

IMPERFORATE ANUS
An imperforate anus or anorectal malformations (ARMs) are birth defects in

which the rectum is malformed. ARMs are a spectrum of different congenital
anomalies which vary from fairly minor lesions to complex anomalies.[1]
Imperforate anus is a defect in which the opening to the anus is missing or blocked.
The anus is the opening to the rectum through which stools leave the body. This is
present from birth (congenital).
INCIDENCE
About 1 out of every 5,000 babies has an imperforate anus or other malformation of
the anus or rectum. It occurs more often in boys than girls. The rectum, bladder, and
vagina of a female baby with an imperforate anus sometimes share one large opening.
This opening is called a cloaca.
Causes
Imperforate anus may occur in several forms:
 The rectum may end in a pouch that does not connect with the colon.
 The rectum may have openings to other structures. These may include the
urethra, bladder, base of the penis or scrotum in boys, or vagina in girls.
 There may be narrowing (stenosis) of the anus or no anus.
It is caused by abnormal development of the fetus. Many forms of imperforate anus

occur with other birth defects.
Clinical Manifestations
Newborns with imperforate anus are usually identified upon the first physical
examination.
 Absence of stool. There is no passage of stool within a day or two of birth.

 Passing of stools in other openings. The infant may pass stools through
another opening like the urethra in boys or vagina in girls.
 Swollen belly. The newborn could not pass out stools, resulting in a swollen
belly.
 Absence of anal opening. The opening of the anus is missing or not in its
usual place; in girls, this may be near the vagina.
Assessment and Diagnostic Findings
A doctor can usually diagnose an imperforate anus by performing a physical exam

after birth. An X-ray of the abdomen and abdominal ultrasound can help reveal the
extent of the abnormalities.
After diagnosing imperforate anus, your baby’s doctor should also test for other
abnormalities associated with this condition. Tests used may include:
Laboratory studies. CBC count, blood typing and screening, and serum electrolyte
levels should be measured in all children with imperforate anus who require
operation; urinalysis should be performed to determine the presence of a rectourinary
fistula in all cases in which the diagnosis cannot be made based solely on the physical
examination findings.
X-rays of the spine to detect bone abnormalities
spinal ultrasound looking for abnormalities in the vertebral body, or bones of the spine
echocardiogram looking for cardiac anomalies
MRI looking for evidence of esophageal defects such as formation of fistulae with the
trachea, or windpipe
Colostogram, to check bowel anatomy
Cystourethrogram, to look at the urinary tract
Echocardiography, to look for heart problems
Chest x-ray, to rule out problems with the trachea and esophagus
Medical Management
Management of an infant with imperforate anus include:
 Nothing per orem. Newborns with imperforate anus should not be fed and
should receive intravenous hydration.
 Neonatal colostomy. A colostomy is performed in children who are not
amenable to primary pull-through either because of malformation complexity (any
urinary fistula in boys, vestibular fistula, and cloaca in girls, no fistula in either sex >1
cm from perineal skin) or associated comorbidity.
 Primary neonatal pull-through without colostomy. Many pediatric surgeons
opt for primary pull-through in children with perineal fistulas (or no fistulas) and
close (< 1 cm) rectal pouches on 24-hour lateral pelvic radiography.
 Posterior sagittal pull-through with a colostomy. This approach is used in
boys with rectourinary fistula (bulbar, prostatic, or bladder-neck fistula), in girls with
cloaca or vestibular fistula, and in patients of either sex who do not have a fistula
when the rectal pouch is further than 1 cm on 24-hour lateral prone abdominal
radiography.
 Colostomy closure. Once the wound has completely healed and postoperative
dilations have achieved their goal (i.e., the neoanus is at the desired size), the
colostomy may be closed in traditional surgical fashion.
 Diet. After the obstruction is relieved using colostomy, primary pull-through,
or dilation, children do not require special diet; children should avoid constipating
foods, such as those included in the bananas, rice, applesauce, and toast (BRAT) diet.
High-fiber and laxative foods (whole-grain foods and bread, dairy, fruits, vegetables,
greasy foods, spicy foods) should be encouraged.
 Activity. Children with anorectal malformations are often otherwise healthy;
activity limitations are usually related only to the period around their surgical
procedures.
Pharmacologic Management
Many children with anorectal malformations require medications for various reasons.
 Antibiotic prophylaxis. Urinary prophylaxis is used to mitigate the risk of

urinary infection and urosepsis in children with risk factors for urinary infection such
as urinary fistula, vesicoureteral reflux, or continent diversion.
 Laxatives. Common laxatives include senna products, milk of magnesia, and
propylene glycol solutions (eg, MiraLax, GlycoLax).
Nursing Management
Nursing care for an infant with imperforate anus include:
Nursing Assessment
Assessment of an infant with imperforate anus include the following:
 History. Prenatal ultrasonography examination findings are often normal,

although the polyhydramnios or intraabdominal cysts may suggest imperforate anus
with associated hydrocolpos or hydronephrosis.
 Physical exam. Newborns with imperforate anus are usually identified upon
the first physical examination; malformations in newborns that are missed upon initial
examination are often discovered within 24 hours when the newborn is observed to
have distention and has failed to pass meconium and a more thorough examination is
performed.
Nursing Interventions
Nursing interventions for a child with imperforate anus are:
 Avoid infection. Teach the caregivers to keep the area around the colostomy
clean with soap and water and to diaper the baby in the usual way; monitor white
blood cell (WBC) count; and wash hands and teach patient and SO to wash hands
before contact with patients and between procedures with the patient.
 Protect skin integrity. A protective ointment is useful to protect the skin
around the colostomy; monitor site of impaired tissue integrity at least once daily for
color changes, redness, swelling, warmth, pain, or other signs of infection; and keep a
sterile dressing technique during wound care.
 Restore balanced fluid volume. Administer parenteral fluids as prescribed;
consider the need for an IV fluid challenge with an immediate infusion of fluids for
patients with abnormal vital signs; teach family members how to monitor output in
the home; instruct them to monitor both intake and output.
References
Nelson Textbook of Pediatrics, 15th Ed.: Richard E. Behrman, Editor; W.B. Saunders
Company, 1996. Pp. 1076-77.
Birth Defects Encyclopedia: Mary Louise Buyse, Editor-In-Chief; Blackwell
Scientific Publications, 1990. Pp. 149-150
Medlin plus encyclopedia. Imperforate Anus Retrieved on 3rd December, 2021
http://www.nlm.nih.gov/medlineplus/ency/article/001147.htm
Pedisurg. Imperforate anus Retrieved on 3rd December, 2021

http://www.pedisurg.com/pteduc/imperforate_anus.htm
Cincinati children. Imperforate anus. Retrieved on 3rd December, 2021 from

http://www.cincinnatichildrens.org/health/i/imperforate-anus/

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IMPERFORATE ANUS

An imperforate anus or anorectal malformations (ARMs) are birth defects in

It is caused by abnormal development of the fetus. Many forms of imperforate anus

 Absence of stool. There is no passage of stool within a day or two of birth.

Assessment and Diagnostic Findings

A doctor can usually diagnose an imperforate anus by performing a physical exam

X-rays of the spine to detect bone abnormalities

echocardiogram looking for cardiac anomalies

Colostogram, to check bowel anatomy

Cystourethrogram, to look at the urinary tract

Echocardiography, to look for heart problems

Management of an infant with imperforate anus include:

 Antibiotic prophylaxis. Urinary prophylaxis is used to mitigate the risk of

Assessment of an infant with imperforate anus include the following:

 History. Prenatal ultrasonography examination findings are often normal,

Nursing interventions for a child with imperforate anus are:

Pedisurg. Imperforate anus Retrieved on 3rd December, 2021

Cincinati children. Imperforate anus. Retrieved on 3rd December, 2021 from

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