Abstract
Objective : To evaluate the incidence, types and the effect on outcome of associated anomalies in neonates with anorectal malformations (ARM).Methods : This retrospective study was carried out on all neonates with ARM admitted to the neonatal surgical intensive care unit (NSICU) from 1998 through 2003.Results : Of the 754 neonates admitted to the NSICU during the study period of 6 years, there were 124 (16.4%) neonates with anorectal malformations. Of these 110 were included in the study. 73 % were male and 27% female. 86% of these were high ARM (HARM) while only 14% were low ARM (LARM). Associated anomalies were seen in 68% of patients. The incidence was 72% for HARM and 50% for LARM. The major associated anomalies consisted of esophageal (13%), gastrointestinal (GIT) (11%), genitourinary (GUT) (32%), skeletal (26%), cardiac (33%) and miscellaneous 26%. The overall survival rate was 84% (82% for HARM and 94% for LARM). The survival among those with associated esophageal anomalies was 43%, GIT 67%, GUT 80%, cardiac 61%, skeletal 76% and miscellaneous 79% respectively. This difference in survival was significant only for those with esophageal (p=0.004) and cardiac anomalies (p=0.0026). The survival rates among those with one, two or more than two organ systems involved with associated anomalies were 88%, 82% and 58% respectively. This difference was significant only for more than two organ systems involvement (p=0.003).Conclusion : Associated anomalies are common in neonates with ARM, the incidence being similar for HARM and LARM. The survival depends upon the number and severity of associated anomalies both in patients with LARM and HARM. Neonates with more number of organ systems involved have a poorer survival specially when associated with esophageal and cardiac anomalies. All neonates with ARM merit a meticulous search for associated anomalies so that the management can be tailored for each baby.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kisewetter WB, Turner CR, Sieber WK. Imperforate Anus: review of sixteen year experience with 146 patients.Am J Surg 1964; 107:412–421.
Parrott TS. Urologic implications of anorectal malformations.Urol Clin North Am 1985; 12(1): 13–21. Review
Hassink EA, Rieu PN, Hamel BC, Severijnen RS, vd Staak FH, Festen C. Additional congenital defects in anorectal malformations.Eur J Pediatr 1996; 155(6): 477–482.
Saeki M. Activities of the Japanese group for the study of ARM.Nippon Geka Gakki Zassli 1984; 85:1196–1200.
Smith ED. Incidence, frequency of types and etiology of ARM.Birth Dejects Orig Artic Ser 1988; 231–246.
Nazer J, Hubner ME, Valenzuela P, Cifuentes L. Anorectal congenital malformations and their preferential associations. Experience of the Clinical Hospital of the University of Chile. Period 1979-1999.Rev Med Child 2000; 128(5): 519–525.
Cho S, Moore SP, Fangman T. One hundred three consecutive patients with anorectal malformations and their associated anomalies.Arch Pediatr Adolesc Med 2001; 155(5): 587–591.
Kos M, Hlupie L, Pejkovic L. Congenital gastrointestinal malformations in a 5 year post mortem series.Acta Med Croatica 2001; 55:229–234.
Partridge JP, Gough MH. Congenital abnormalities of the anus and rectum.Br J Surg 1961; 49: 37–50.
Swenson O, Donnellan WL. Preservation of the puborectalis sling in imperforate anus repair.Surg Clin North Am 1967; 47: 173.
Boocock GR, Donnai D. Anorectal malformation: familial aspects and associated anomalies.Arch Dis Child 1987; 62: 576–579
Mittal A, Airon RK, Magu S, Rattan KN, Ratan SK. Associated anomalies with anorectal malformation (ARM).Indian J Pediatr 2004; 71(6): 509–514.
Chalapathi G, Choudhary SK, Rao KLN, Samujh R, Narasimhan KL, Mahajan JK, and Menon P. Risk factors in the primary management of anorectal malformations in north India.Pediatr Surg Int 2004; 20: 408–411.
Metts JC III, Kotkin L, Kasper S, Shyr Y, Adams MC, Brock JW III. Genital malformations and coexistent urinary tract or spinal anomalies in patients with imperforate anus.J Urol 1997; 158(3 Pt 2): 1298–1300.
Boemers TM, de Jong TP, van Gool JD, Bax KM. Urologie problems in anorectal malformations.Part2: functional urologie sequelae.J Pediatr Surg 1996; 31(5): 634–637.
Hall JW, Tank ES, Lapides J. Urogenital anomalies and complications associated with imperforate anus.J Urol 1970; 103:810–814.
Wiener ES and Kiesewitter WB. Urologie abnormalities associated with imperforate anus.J Pediatr Surg 1973; 8: 151–157.
Cortes D, Thorup JM, Nielsen OH, Beck BL. Cryptorchidism in boys with imperforate anus.J Pediatr Surg 1995; 30(4): 631–635.
Sangkhathat S, Patrapinyokul S, Tadtayathikom K. Associated genitourinary tract anomalies in anorectal malformations: a thirteen year review.J Med Assoc Thai 2002; 85(3): 289–296.
Taskinen S, Valanne L, Rintala R. Effect of spinal cord abnormalities on the function of the lower urinary tract in patients with anorectal abnormalities.J Urol 2002; 168(3): 1147–1149.
Khoury MJ, Cordero JF, Greenberg F, James LM, Erickson JD. A population study of the VACTERL association: evidence for its etiologic heterogeneity.Pediatrics 1983; 71(5): 815–820.
Sukawat W, Anant S, Thavatchai L, and Thongkhao R. Association of Hirschsprung’s Disease and Anorectal malformation.J Pediatr Surg 1991; 26:192–195.
Kieswetter WB, Sukarochana K, Sieber WK. The frequency of aganglionosis associated with imperforate anus.Surgery 1965; 58:877–880.
Cloutier R, Archambault H, Amours CD, Levasseur L, and Ouellet D. Focal ectasia of the terminal bowel accompanying low anal deformities.J Pediatr Surg 1987; 22: 758–760.
Agarwala S, Goswami JK, Mitra DK. Pyloric atresia associated with epidermolysis bullosa, malrotarion, and high anorectal malformation with recto-urethral fistula: a report of successful management.Pediatr Surg Int 1999; 15:264–265.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, A., Agarwala, S., Srinivas, M. et al. Anorectal malformations and their impact on survival. Indian J Pediatr 72, 1039–1042 (2005). https://doi.org/10.1007/BF02724407
Issue Date:
DOI: https://doi.org/10.1007/BF02724407