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Paediatric anorectal malformations

OVERVIEW

An anorectal malformation is a congenital condition where the rectum and anus of the foetus do not develop properly during pregnancy. These structures form the lower segment of the digestive tract.

Newborns with anorectal malformations may exhibit an absent or narrowed anus. The narrowed anus is known as a fistula. Alternatively, they might have an obstruction caused by a layer of tissue blocking the anus or rectum. In some cases, there may be abnormal connections between the rectum and the urinary system.

Finding out that your baby has an anorectal malformation can be worrisome. If left untreated, it may lead to intestinal obstruction, resulting in difficulties or inability to pass stool. However, prompt treatment after birth, usually through surgical repair within a few days, yields favourable outcomes.

Types of anorectal malformations

Anorectal malformations in children encompass a variety of abnormalities that affect the development of the rectum and anus. The different types include:

Anal stenosis: In this type, the anus is abnormally narrow, making it challenging for stool to pass through.
Rectoperineal fistula: This malformation occurs when there is an abnormal connection between the rectum and the perineal area, resulting in the anus opening in an incorrect location.
Rectovestibular fistula: Specific to females, this type involves a connection between the rectum and the vestibule, leading to stool passing into the vaginal area.
Rectourethral fistula: This malformation occurs in males and there can be a communication to the lower urethra (membranous), upper urethra (prostatic) or sometimes to the bladder
Rectal atresia: There is a narrowing of the rectum causing bowel obstruction in newborns.
Cloaca: This complex malformation involves a single common channel where the rectum, urinary tract, and reproductive organs share an opening.

Symptoms of anorectal malformations

An anorectal malformation is typically identified by a healthcare provider during a routine examination of a newborn. They may observe a narrowed or absent anus or an abnormal location of the anal opening.

If an anorectal malformation goes unnoticed initially, infants may exhibit symptoms such as:

Difficulty in passing stool, leading to constipation.
Leakage of stool from the vagina or the presence of visible stool in the urine.

Treatment

Surgical intervention is the usual approach for treating anorectal malformations by healthcare providers. They may perform a single procedure to address a narrowed passage or remove tissue that obstructs the child's anus. Additionally, anorectoplasty, a reconstructive procedure, may be conducted to restore the anus.

In the case of babies with anorectal malformations, a series of surgeries are typically performed to establish a connection between the rectum and anus. These surgeries include:

Colostomy: The surgeon divides the large intestine and brings both ends to the surface through abdominal openings. Infants wear external collection bags to allow stool and mucus to pass outside the body.
Anorectoplasty : Typically performed when the baby is a few months old, this procedure involves placing the rectum within the sphincters and creating the new anus.. While healing from the surgery, stool continues to exit the body through the colostomy bag.

Colostomy closure: Approximately two to three months after the second surgery, a procedure is carried out to remove the colostomy Following this, children gradually begin passing stool through their rectum within a few days.

These surgical interventions aim to establish proper bowel function and enable the child to pass stool normally.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1Will my child be able to have normal bowel movements after treatment?

In most cases, with appropriate surgical treatment, children with anorectal malformations can achieve normal bowel function. However, the specific outcome depends on the complexity of the malformation and individual circumstances. Follow-up care, including bowel management programs and dietary modifications, may be necessary to optimise bowel movements.

2Are there long-term complications associated with anorectal malformations?

Some individuals may experience long-term complications such as bowel control issues (faecal incontinence), constipation and urinary problems. However, with proper medical management, these complications can often be minimised or effectively addressed.

3What is the prognosis for children with anorectal malformations?

The prognosis varies depending on the specific malformation, its severity, associated anomalies, and the effectiveness of surgical treatment. With timely intervention and appropriate care, many children can lead healthy and normal lives.