Anorectal malformations are birth defects where the anus and rectum do not develop properly. They can range from low anomalies where the rectum is normally positioned to high anomalies where it is further up. Common symptoms include lack of passing meconium or it passing from abnormal openings. Management involves admitting the child to the hospital, withholding oral feeding, reassuring parents, and maintaining warmth. Surgery like posterior sagittal ano-rectoplasty is then performed to repair the defect. Post-operative nursing care focuses on airway monitoring, pain management, wound care, and emotional support for the family.

4. Normal Pelvis Anorectal Malformation

5. Anorectal malformation
Introduction
Anorectal malformations are birth defects or
developmental deformities of the lower end of the
alimentary tract that is anorectal canal. With this
defect, the anus and rectum don’t develop properly.
They are the lower part of the digestive tract.

6. Anorectal Malformation

7. Incidence
 Kanti Children's hospitals have served a total of 103
patients in the Surgical ICU of Kanti Children’s
Hospital, from October to December 2018. Anorectal
malformation 9(October), 7 (November),6(December)
Source:- https://realmedicinefoundation.org/wp-
content/uploads/2019/09/RMF_Nepal___Kanti_Childr
en_s_Hospital___Q4_2018.pdf

10. Classification
1.Low anomalies: The rectum has decended normally
through the puborectalis muscle, the internal and
external sphincters are present and well developed with
normal function and there is no connection to the
genitourinary tract. In low anomalies, there is 1.5 cm or
less between the blind end of colon and anal dimple.

12. Classification Contd…
2. Intermediate anomalies:- The rectum is at the or
below the level of the puborectalis muscle; the anal
dimple and external sphincter are positioned normally.

13. Classification Contd…
3.High anomalies:- The rectum ends above the puborectalis
muscle and there is absence of the internal sphincter.
This is usually associated with a genitourinary fistula
(recto urethral in male or rectovaginal in female). In high
anomalies, there is more than 1.5cm between the blind
end of colon and anal dimple.

14. Clinical presentation
 Absence of anal opening or abnormally formed anal
opening at birth (during perineal examination)
 Absence of meconium
 Meconium discharge from other site than anus
 Progressive distension of abdomen that may associate
with vomiting.

15. Feature according to type of
defects
 Imperforated anus:- Infants fails to pass meconium,
and greenish bulging membrane is seen on
examination.

16. Feature according to type of
defects
 Anal stenosis :- Infants passes ribbon like stools with
difficulty

17. Feature according to type of
defects
 Rectovaginal fistula: it is the communication between
rectum and vagina and stool passes through the
vagina.

18. Feature according to type of
defects
 Rectoperineal fistula: it is manifested as small orifice
in the perineum. In male baby it is found close to the
scrotum and in female at the vulva.

21. Management
 Admit the child in tertiary level hospital.
 With hold oral feeding.
 Reassure the parents and explain the nature of
anomalies as well as treatment process.
 Maintain warmth to prevent baby from hypothermia.
 Nutrition- feedings is started soon after surgical
repairment and breast feeding is encouraged to
minimize the risk of constipation.

22. Surgery
 Anal dilation :- It is a procedure to slowly stretch out
the anal opening. It is done before and after surgery to
allow stool and gas to pass easily through anal
opening.

23. Surgery
 A posterior sagittal ano-rectoplasty (PSARP) is a
procedure that is used to repair anorectal
malformations which create surgically the child’s anus
within the sphincter muscle.

24. Nursing Management
 Assessment:
Nursing assessment should focus on pass of
meconium within 48 hours of birth, and stool come
from any abnormal opening.

25. Nursing Diagnosis
 Fluid volume deficit related to excessive loss through
vomiting.
 Impaired skin integrity related to the colostomy.
 Risk for infection related to surgical procedures

26. Nursing Interventions
 Monitor site of impaired tissue integrity at least once
daily for colour changes, redness, or other signs of
infection.
 A protective ointment is useful to protect the skin
around the colostomy.
 Wash hands before contact with patients and between
procedures with the patient.
 Administer parenteral fluids as prescribed.

27. Pre operative care
 Assess vital monitoring and proper recording, inform
parents about baby's condition
 Keep NPO, written Consent, measurement of
abdominal surgical girth.
 Physical preparation, pre-medications, and collection
of report.

28. Post operative care
 Maintain airway status, pain management.
 Care of soakage from suture site and other immediate
post surgery care.
 Provide post-operative medication.
 Emotional support for family

29. Complication
 Intestinal obstruction
 Urinary tract infection
 Colostomy infection
 Anal stenosis

31. REFERENCE OF ANORECTAL
MALFORMATION
 Uprety K, Child Health Nursing, fourth Edition (2071 Bhadra), Tara
Books and Stationery, Chhetrapati, Kathmandu, pg 138- 140
 Shrestha T. Essential Child Health Nursing. first Edition 2015,August.
Medhavi Publication; Jamal, Kathmandu Page no.286-290
 WilsonD, Rodgers CC, Hockenberry M, Wongs Essential of pediatric
Nursing 10 th edition, ELSEVIER, page no 1422-1425
 Adhikari T, Essential of Pediatric Nursing, first 2014 edition, vidyarthi
pustak bhadar, bhotahity, Kathmandu, page no177-182
 https://www.urmc.rochester.edu/encyclopedia/content.aspx?contentty
peid=90&contentid=P01980#:~:text=Anorectal%20malformations%20a
re%20birth%20defects,end%20of%20the%20large%20intestine
 https://realmedicinefoundation.org/wp-
content/uploads/2019/09/RMF_Nepal___Kanti_Children_s_Hospital_
__Q4_2018.pdf
 https://www.ncbi.nlm.nih.gov/books/NBK542275/