The document discusses anorectal malformations in children. It defines anorectal malformations as anomalies of the rectum and distal anus that can range from simple imperforate anus to complex anomalies involving the genitourinary and pelvic organs. Signs may include failure to pass meconium or stool leaking through abnormal openings. Treatment involves stabilization, surgery such as colostomy or posterior sagittal anorectoplasty, and lifelong bowel management. Postoperative care focuses on meticulous perineal care and prevention of complications.

1. PRESENTED TO:-
Mrs Anita Asrani mam
Ms Pinky pathidar mam
PRESENTED BY:-
JECIKA JOSHWA
Bsc Nursing 3rd year
SUBJECT :- CHILD HEALTH NURSING

3. Anorectal malformation refer to anomalies of the
rectum and distal anus, the urinary tract ,and the
genital tract .
These malformation may range from simple
imperforate anal to include other associated
complex anomalies of genitourinary (GU) and
pelvic organ.
Which may require extensive treatment for fecal
, urinary ,and sexual function .
 Anorectal malformation are frequently associated
with other anomalies .some babies have VACTERL
conditions.

5. Anorectal malformation
are congenital
malformation caused by
abnormal development of
the rectum and anus .

7. The exact cause of these malformation
is not known. It occurs due to the arrest
in the embryonic development of the
anus , lower rectum and urogenital
tract at the 8 th week of embryonic life
The membrane that separatevthe
endodermal hindgut from the
ectodermal and dimple perforates and a
continuous canal is formed, the outlet
of which is the anus.

8. If the membrane separating the
rectum from the anus is not
absorbed, and if the union does not
take place,an anorectal anomaly
results
Approximately 40% of the neonates
with anorectal malformations have
associated anomalies like Down's
syndrome , congenital heart disease
, undescended tests, renal
abnormalities , esophageal atresia

10. A. Infant with out normal anus
 With a visible abnormal opening
1. Anal stenosis
2. Ano perineal fistula
3. Anovestibular fistula
 With an invisible but manifested opening of the bowel
1. Rectovagainal fistal
2. Recto urethral fistula
3. Rectovestibular fistula
 No manifested opening of the bowel
1. Persistent anal membrane
2. Rectal atresia

11.  1) Anal stenosis :- which is narrowing of the canal
that makes it difficult to pass stool , can lead to serious
complications it left untreated. Also referred to as
stricture , this condition occurs when the muscle in the
anus - which expand and contract to regulate the
passage of the fecal material - narrow

12.  The presence of a fistula (abnormal tunnel ) between
the anal canal and the perineum
 3) Anovestibular fistula(AVF) is the most common
form of anorectal anomaly in female infants

13.  1) Rectovagainal fistula :- It is an abnormal
connection between the lower portion of
your large intestine — your rectum—and your
vagina. Bowel content can leak through the
fistula , allowing gas or stool to pass through
your vagina

14. It is a connection between the lower urinary
tract and the distal part of the rectum .RUFs
are rare conditions and can be classified as
congenital or acquired.
 3) Rectalvesicular fistula :- it is an
abnormal connection between the rectum
and the urinary bladder .

23.  No or abnormally formed anal opening .
 Failure to pass meconium within the first 24 hours
of birth may be indicative of imperforate anus.
 Fistula
 Presence of mechonium in urine
 Progressive abdominal distention
 Vomiting
 Rectal tube cannot be inserted
 Imperforate anus

25.  Physical examination by passing the gloves little finger
through the anus and by observing the passage through
which meconium was passed .
 Cystoscopy
 An IV pyelogram and a voiding cystourethrogram are
performed to evaluate associated anomalies involving
the urinary tract .

27.  Newborn is stabilized and kept NPO for
further evaluation
 IV fluids are provided to maintain glucose
and fluid and electrolyte balance
 Current recommendation is that surgery be
delayed at least 24 hours to properly
evaluate for the presence of a fistula and
possibly other anomalies

28.  Various according to the defect
 Low ARM
 Rectal cut back anaplasty or Y-V plasty
 Dialation of fistula
 High ARM
 Colostomy
 Posterior sagittal anorectoplasty (PSARP) or
other pull- through with colostomy .

29.  This surgery generally occur between 3 to 6 months
of age , although timing varies among surgeons.
 When the operative site has healed , approximately 2
weeks after surgery , anal dilations are begun.
 When the desired size of the anal opening has been
achieved, the colostomy is closed.
 In case of imperforate anal membrane , the memy is
perforated with a blunt instrument. Repeated
dilations might be necessary to prevent scar
formation.
 In case of fistulas, the colon can be brought down
through the anal dimple by an abdominoperineal
procedure. The anus is positioned in the area of

46.  Gastric suction may be done
 Withhold oral feedings
 Start parenteral hydration
 Measurements of abdominal girth
 Intake output chart
 Consent from parents
 Pre- medication

48.  Scrupulous perineal care
 Change perineal dressing whenever soiled.
 Apply protective ointments such as zinc oxides to
decrease skin irritation.
 Position baby in a side- lying or a supine position
with the legs suspended at a 90° angle to the
trunk to prevent pressure on perineal sutures.
 Intravenous feedings till the wound heals or until
peristalsis appear.
 Prevention of constipation by exclusive
breastfeeding and proper weaning with stool
softeners or fibers.
 Bowel habit training

49.  Daily enemas until control are achieved if
necessary.
 Do not use diaper in case of anoplasty
 Colostomy care by changing the collection
device and meticulous skin care .
 Family support , discharge planning and
home care

56.  Rectovesicular fistula. Rectourethral fistula

57.  All patients born with anorectal
malformations can be kept clean of stool and
dry of urine , either because they achieve
bowel control or because they are subjected
to a bowel management program

58.  Manoj yadav "A textbook of Child health nsg
 Edition 2011 published by s.vikas and
 Company
 Parul Datta " Pediatric Nursing"
 2nd edition published by Jaypee
Brothers
 Internet :-
 www.slideshare .com
 Wikipedia