Imperforate Anus
By: Gracy C. Espino
Normal anatomy
• In individuals with normal anatomy, the
large intestines (colon) empties into a pouch
like portion of the bowel (rectum). Through
complex nerve and muscle structures, the
rectum releases stool through the anus out of
the body.
Imperforate anus
• Is stricture of the anus.
• is a defect that is present
from birth (congenital).
• The lower bowel ends in a
blind pouch.
Imperforate anus
Is a malformation of the anorectal region
that may occur in several forms.
– The rectum may end in “blind pouch”
– it may have openings in the urethra, bladder
or vagina
– Narrowing of the anus
– Absence of the anus
Imperforate anus
it may have openings in the urethra, bladder
or vagina
Imperforate anus
• Occurs 1 in 5,000 live births more
commonly in boys than girls
• May occur as an additional
complication of spinal cord
disorders, because both the
external canal and the spinal cord
arise from the same germ tissue
layer.
Cause:
• The cause is unknown.
• The condition develops in utero
during the fifth to seventh weeks
of pregnancy.
Cause:
• In week 7 of intrauterine life, the upper
bowel elongates to pouch and combine with
a pouch invaginating from the perineum.
These two sections of bowel meet, the
membranes between them are absorbed,
and the bowel is then patent to the outside.
• If this motion toward each other does not
occur or if the membrane between the two
surfaces did not dissolve, imperforate anus
occurs.
Signs and symptoms
• no anal opening
• anal opening in the wrong place, such as
too close to the vagina
• no stool in the first 24 to 48 hours of life
• stool passing through the wrong place,
such as the urethra, vagina, scrotum, or
the base of their penis
Signs and symptoms
• abdominal distention
• an abnormal connection, or fistula,
between your baby’s rectum and their
reproductive system or urinary tract
How Is Imperforate Anus
Diagnosed?
• Physical exam after birth.
• X-rays of the abdomen
• abdominal ultrasound
- a head down position to allow
swallowed air to rise to the end of
the blind pouch of the bowel
Treatment
• Surgical repair involves creating an
opening for passage of stools
Treatment
• Temporary colostomy can also allow the
baby time to grow before surgery.
Treatment
• A perineal anoplasty,
the surgeon closes any
fistulas so that the rectum
no longer attaches to the
urethra or vagina. They
then create an anus in
the normal positioning
Treatment
• A pull-through operation is when the
surgeon pulls the rectum down and
connects it to the new anus.
Nursing Management:
• Preoperative Care:
Keep on NPO to avoid further bowel
distention
Nasogastric tube attached to low intermittent
suction for decompression will be inserted to
relieve vomiting and prevent pressure on the
other organs or the diaphragm from the distended
intestine.
Intravenous therapy to maintain fluid and
electrolyte balance
Nursing Management:
• Postoperative Care:
small oral feedings of glucose water, breast
milk if bowel sounds are present and the NGT is
removed.
If with temporary colostomy, low residue foods
(cereal, rice, fruits and vegetables) to lessen bulk
of stools. Avoiding vegetables with fiber or fruit
with peels.
Nursing Management:
• Place a diaper under, not on the infant so BM
can be cleansed away as soon as they occur.
• Do not place the infant on the abdomen
because in this position, newborns tend to pull
their knees under them causing tension in the
perineal area. A side lying position is best.
Nursing Management:
• Rectal dilatation once a day or twice for a
few months after surgery to ensure proper
patency of the rectal sphincter.
- Gently a lubricated cot-covered finger
into the rectum
Thanks for listening
