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Imperforate Anus |
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What is imperforate anus?
Imperforate anus is the absence of a normal anal opening. The
diagnosis is usually made shortly after birth by a routine
physical examination. Imperforate anus occurs in about 1 in 5000
births and its cause is unknown.
Children who have imperforate anus may also have other congenital
anomalies. The acronym VACTERL describes the associated problems
that infants with imperforate anus may have: Vertebral defects,
Anal atresia, Cardiac anomalies, Tracheoesophageal fistula,
Esophageal atresia, Renal anomalies, and Limb anomalies. The
incidence of kidney and bladder problems increases with the
severity of the imperforate anus, ranging from 5 to 20 percent
with low lesions up to 60 to 90 percent with high lesions. While
some of these anomalies may be noted on physical examination,
others require further diagnostic tests. Renal ultrasound is done
shortly after birth on all infants to evaluate the kidneys. Chest
X-ray, EKG, and cardiac ultrasound may be ordered to evaluate the
heart. Other X-rays may be done to evaluate the trachea and
esophagus and the spine.
How is imperforate anus evaluated?
Although the diagnosis of imperforate anus can be made by physical
examination, it is often difficult to determine whether the infant
has a high or low lesion. A plain radiograph of the abdomen can
help locate the lesion. Ultrasound of the perineum (rectal and
vaginal areas) is also useful: with ultrasound we can determine
the distance between a meconium-filled distal rectum and a finger
on the perineum; we can also determine if there are any anomalies
of the urinary tract or the spinal cord.
What is the long-term outlook for
children after repair of imperforate anus?
The most important prognostic feature is the severity of the
imperforate anus and the presence or absence of associated spinal
abnormalities. Children with a low lesion, especially those who
require only a perineal anoplasty, have a very good chance of
having normal stool patterns. Children with spinal abnormalities
of the lower sacrum and a high imperforate anus have a poorer
chance of obtaining normal bowel function. Even this latter group,
however, are helped by a bowel training program with diet changes
and use of stimulant cathartics and regular enemas.
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