2. Definition:
⢠ARMs are developmental deformities of the lower end of the alimentary tract,
i.e., the anorectal canal.
⢠The term imperforate anus is used to describe all congenital abnormalities of
the anorectal canal or in location of the anus within the perineum.
3. Incidence:
⢠Minor abnormalities of the anus and rectum occur in 1 of 500 living
newborns, while major abnormalities occur in 1 of 5000 living
infants.
6. Classification:
⢠Classification of ARMs can be done into three groups in the infants without a normal anus.
1. With a visible abnormal opening of the bowel:
a. Anal stenosis
b. Anoperineal fistula
c. Anovestibular fistula in female
2. With an invisible but manifested opening of the bowel:
a. Rectovaginal fistula in female
b. Rectourethral fistula in male
c. Rectovesicular fistula
3. No manifested opening of the bowel:
a. Persistent anal membrane
b. Rectal atresia
7. CONTDâŚ..
⢠Anorectal malformations can be classified into two groups on the basis of levator ani muscle, which is the
main muscle of fecal control:
1. Supralevator or high anorectal malformations:
⢠When rectum terminates above the levator ani muscle, which is found as rectal atresia, rectoprostatic fistula
and rectovaginal fistula. About 30% of children with high ARMs or associated genitourinary fistula achieve
bowel continence.
2. Translevator or low anorectal malformations:
⢠When rectum terminates below the levator animuscle, e.g., in anocutaneous fistula and Anovestibular fistula.
About 90% of children with low ARMs achieve bowel incontinence.
8. Clinical Manifestations:
ď Absence of stool. There is no passage of stool within a day or two of
birth.
ď Passing of stools in other openings. The infant may pass stools
through another opening like the urethra in boys or vagina in girls.
ď Swollen belly. The newborn could not pass out stools, resulting in a
swollen belly.
ď 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.
9. The specific features for specific anomalies
⢠Imperforate Anal Membrane:
Infant fail to pass meconium. Greenish bulging membrane seen on examination.
⢠Anal Stenosis:
It accounts for 10% of all ARMs. The baby may pass ribbon like stools with difficulty
as the anal opening is very small.
⢠Anal Agenesis:
It presents with only anal dimple. Intestinal Obstruction may develop.
10. ⢠Rectal Agenesis:
It accounts 75% of all ARMs. It presents with fistula & can observe in male baby.
⢠Rectoperineal fistula:
It is found in small orifice in the perineum. In male baby it is found close to the scrotum and
in female in the vulva.
⢠Rectovaginal Fistula:
It presents with a communication between rectum and vagina and stool passed through the
vagina.
11. Diagnostic Evaluation:
ď HC
ď PE
ď Laboratory Studies- CBC, Blood Typing & Screening
ď Sacral Radiography
ď Abdominal USG
ď X-ray with inverted infant (upside down position), i.e., invertogram or wangensteen
Rice X-ray is useful to locate rectal pouch
ď Urine examination
ď Spinal ultrasonography or MRI
ď Lateral pelvic radiography at 24 hours.
ď Micturating cystourethrogram- to detect urinary abnormalities
12. Management:
Medical Management:
ď Nothing per mouth
ď Neonatal colostomy.
ď Primary neonatal pull-through without colostomy.
ď Diet.
ď Activity.
ď Laxatives
ď Antibiotic Prophylaxis
15. Nursing Considerations:
Nursing Diagnosis
⢠Based on the assessment data the major nursing diagnoses are:
ď Fluid volume deficit related to excessive loss through vomiting.
ď Impaired skin integrity related to the colostomy.
ď Risk for infection related to surgical procedures.
16. Nursing Considerations:
⢠Nursing Interventions
⢠Nursing interventions for a child with imperforate anus are:
â˘
ď Avoid infection.
ď Protect skin integrity.
ď Restore balanced fluid volume.
17. Complications:
ď UTI
ď Intestinal Obstruction
ď Fecal impaction
ď Colostomy related problems
ď Recurrence of fistula
ď Anal stenosis
ď Postoperative complications
18. Bibiliography:
ď Wongâs. (2005), Essentials of Pediatric nursing, 7th Edition, Elsevier Publications, New Delhi. Page no:
883- 885.
ď Parul Datta. (2007), Pediatric Nursing, 4th Edition, Jaypee publications, New Delhi. Page No: 271-273.
ď Dorothy R. Marlow (2008), Textbook of Pediatric Nursing, 6th Edition, Elsevier publications, New Delhi.
Page No: 457-459.
ď Rimple sharma(2017), Essentials of Pediatric Nursing, 2nd Edition, Jaypee publications, New Delhi.
Page No: 313-317
Websites:
⢠https://nurseslabs.com/imperforate-anus/
⢠https://www.slideshare.net/VipinChandran21/anorectal-malformation-110975114