Anorectal malformations are birth defects where the anus and rectum do not develop properly. They can be classified based on whether there is a visible or invisible opening, and include conditions like anal stenosis, anal fistulas, and rectovaginal fistulas. Diagnosis involves physical exams and imaging tests. Treatment requires reconstructive surgery to repair the anomalies, with techniques depending on the type and sex of the infant. Nursing care focuses on pre/post-op support, maintaining warmth/fluids, and bowel training. Umbilical malformations include abnormalities of the vitelline duct, hernias, exomphalos where intestines protrude from the abdomen, and gastroschisis where intestines

1. ANO-RECTAL
MALFORMATIONS
MS. PRIYANKA J SOLANKI
ASSISTANT PROFESSOR

2. DEFINITION
• Anorectal malformations are birth defects, or
problems that happen as an unborn baby is
developing during pregnancy. With this defect, the
anus and rectum don't develop properly. They are
the lower part of the digestive tract. Ano means the
anus.

4. CLASSIFICATION
1. With a visible abnormal opening of the bowel:
A. Anal stenosis
B. Anoperineal fistula
C. Anovestiular fistula in female

5. ANAL STENOSIS
• Anal stenosis, which is a narrowing of the anal canal
that makes it difficult to pass stool, can lead to serious
complications if left untreated. Also referred to as anal
stricture, this condition occurs when the muscles in
the anus – which expand and contract to regulate the
passage of fecal material – narrow.

7. ANOPERINEAL FISTULA
• A perineal fistula is a type of anorectal malformation
(ARM) that involves a misplaced anal passage that is
often narrowed. With a perineal fistula, the abnormal
anal opening is located outside of the sphincter muscle
complex, such that the fistula usually has very few
voluntary sphincter muscle fibers surrounding it.

9. ANOVESTIULAR
FISTULA
• A rectovestibular fistula, also referred to simply
as a vestibular fistula, is an anorectal congenital
disorder where an abnormal connection (fistula)
exists between the rectum and the vulval
vestibule of the female genitalia.

11. 2. With an invisible but manifested opening of the bowel:
A. Rectovaginal fistula in female
B. Rectourethral fistula in male
C. Rectovesicular fistula

12. RECTOVAGINAL FISTULA
IN FEMALE
• A rectovaginal fistula is an abnormal connection
between the lower portion of large intestine — rectum
— and vagina. Bowel contents can leak through
the fistula, allowing gas or stool to pass through vagina.

14. RECTOURETHRAL
FISTULA IN MALE
• A rectourethral fistula is an abnormal hole that forms
between the urethra and the rectum. In patients who
have a rectourethral fistula, problems can include
passage of urine through the rectum, repeated infections,
and swelling and discomfort in the pelvis.

16. RECTOVESICULAR
FISTULA
• A rectourethral fistula is an abnormal hole that forms
between the urethra and the rectum. In patients who
have a rectourethral fistula, problems can include
passage of urine through the rectum, repeated infections,
and swelling and discomfort in the pelvis.

18. 3. No manifested opening of the bowel:
A. Persistent anal membranes
B. Rectal atresia

19. PERSISTENT ANAL
MEMBRANES
• Imperforate Anus. Imperforate anus, which occurs in 1 of
every 4000 to 5000 births, includes a spectrum of anal defects
that can range from a simple membrane covering
the anal opening (persistence of the cloacal membrane) to
atresia of various lengths of the anal canal, rectum, or both.

21. RECTAL ATRESIA
• Rectal atresia or stenosis is an extremely rare anorectal
malformation associating a normal anal canal with a
stricture or a complete rectal atresia. We describe a case
of rectal atresia in a newborn female presenting with an
abdominal distension and failure of passing meconium.

22. Diagnostic evaluation
• Physical examination of the neonates
• USG helps to locate the rectal pouch
• X-ray
• Examination of presence meconium and epithelial
debris

23. MANAGEMENT
• The reconstructive surgery is done to correct or repair the
congenital malformations. It depends upon the type of
anomalies and sex of infant.
• Rectal cut back anoplasty done in male and dilation of fistula
with definite repair or perineal anoplasty is performed in
female infants.

24. NURSING
MANAGEMENT
• Basic preoperative and postoperative care should be
provided as for abdominal surgery.
• Special interventions like; maintenance of warmth, fluid and
electrolyte balance, general stability of infant.
• Emotional support provided.
• Prevention fecal impaction, bowel habit training, and need
for medical help.

25. UMBILICAL
MALFORMATIONS

26. A. Abnormalities related to vitello-intestinal duct
B. Umbilical hernia
C. Examphalos and gastroschisis

27. Abnormalities Related To
Vitello-intestinal Duct
• Patent vitellointestinal duct: In some cases, the
connection to the intestines remains open. This is
called a patent vitello-intestinal duct that drains
fecal matter at the umbilicus. This needs a surgical
procedure for correction wherein by an abdominal
operation the intestines are disconnected from the
umbilicus.

29. • Patent urachus: Patent urachus repair is surgery to fix a
bladder defect. In an open (or patent) urachus, there is an
opening between the bladder and the belly button (navel).
The urachus is a tube between the bladder and the belly
button that is present before birth.

31. • Umbilical granuloma: An umbilical granuloma is a moist, red
lump of tissue that can form on a baby's navel (belly button).
It can be seen in the first few weeks of life, after
the umbilical cord has dried and fallen off.

32. • Umbilical polyp or adenoma: An umbilical adenoma is a
patch of vitellointestinal epithelium left behind when the
vitellointestinal duct closed. It may form in a deep sinus in the
depths of the umbilicus, but commonly protrudes to from it
like a raspberry.

33. Umbilical hernia
• An umbilical hernia creates a soft swelling or bulge near
the navel. It occurs when part of the intestine protrudes
through the umbilical opening in the abdominal
muscles. Umbilical hernias in children are usually
painless.

34. Exomphalos
• Exomphalos is a weakness of the baby's abdominal wall
where the umbilical cord joins it. This weakness allows
the abdominal contents, mainly the bowel and the liver
to protrude outside the abdominal cavity where they are
contained in a loose sac that surrounds the umbilical
cord.

36. GASTROSCHISIS
• Gastroschisis is a birth defect of the abdominal (belly)
wall. The baby's intestines are found outside of the
baby's body, exiting through a hole beside the belly
button. The hole can be small or large and sometimes
other organs, such as the stomach and liver, can also be
found outside of the baby's body.