Anorectal malformation is a birth defect involving defects of the distal anus and rectum that occurs during fetal development between 4-16 weeks gestation. It occurs when the rectum fails to properly connect to the anus. Major abnormalities occur in about 1 in 5,000 live births and more commonly affect boys. Surgical correction depends on the specific type of defect but may include anoplasty, temporary colostomy, or posterior sagittal anorectoplasty. Nursing management focuses on withholding oral feeding, providing IV fluids and gastric decompression, and carefully monitoring the infant post-operatively.

1. ANORECTAL MALFORMATION

2. ANORECTAL MALFORMATION
Definition:
Anorectal malformation comprise a wide variety of
defects involving distal anus and rectum as well as
the urogenital tract.
It involves an arrest of rectal descent resulting in
absence of an anal opening which occurs during the
4th- 16th week of gestation.

3. INCIDENCE & ETIOLOGY:
Minor abnormalities (1 in 500 live births)
Major abnormalities (1 in 5000 live births)
Boys commonly affected than girls.
Etiology is unclear, Mutation in the genes responsible
for this disorder.

4. PATHOPHYSIOLOGY:
Resulting in Anorectal Anomaly
Union of anus and rectum does not occur
If the membrane that separates anus and rectum is not absorbed
By the 7th week of gestation membrane separates the rectum from anus
Genitourinary tract originates from the embryonic structure called CLOACA

5. CLASSIFICATION:
There are basically 4 types of Anorectal anomalies:
1) ANAL STENOSIS
2) ANAL MEMBRANE ATRESIA
3) RECTAL ATRESIA
4) ANAL AGENESIS/ IMPERFORATE ANUS
LOW
IMPERFORATE
ANUS
INTERMEDIATE
IMPERFORATE
ANUS
HIGH
IMPERFORATE
ANUS

7. DIAGNOSTIC EVALUATION:
Detection of imperforate anus can be done at birth, on
following findings:
i. No anal opening
ii. Gloved finger or thermometer cannot be inserted into
infant rectum
iii. No history of passage of meconium
iv. Presence of abdominal distension
v. Presence of meconium in urine, indicating rectovaginal
fistula.

8. To find out the distance between blind end of rectum
and anal dimple following investigation are done:
1) Invertogram
2) Abdominal ultrasound
3) Intravenous pyelogram (kidney, ureter, urinary
bladder)

9. MANAGEMENT:
Two aspect must be considered during the first 24- 28
hours of life:
First is the presence of associated anomalies that
may threaten the baby life.
Severity of defect
Surgical procedure depends on the types of anomaly
Anoplasty
Temporary colostomy
Posterior sagittal anorectoplasty (PSARP) OR Pena’s
procedure

10. NURSING MANAGEMENT:
Pre- operative nursing care:
i. After birth, as soon as the anomaly is noticed, oral
feeding should be withheld.
ii. I/V fluids are started to meet nutritional
requirement
iii. Abdominal girth should be measured.
iv. Gastric compression should be done by
nasogastric aspiration.
v. Monitor vital signs, prepare the family
psychologically for infant’s surgery.

11. Post- operative care:
i. I/V fluids are to be continued.
ii. Nasogastric suction is continued.
iii. Oral feeding are started when peristalsis returns.