This document discusses anorectal malformations, which involve defects of the distal anus and rectum. It may involve absence of an anal opening. Boys are more commonly affected than girls. Types include anal stenosis, anal membrane atresia, rectal atresia, and anal agenesis. Diagnosis involves newborn assessment and tests like ultrasound and intravenous pyelogram. Surgical procedures depend on the type but may include dilation, incision of membranes, or multi-stage procedures including temporary colostomy. Post-operative nursing care focuses on general care, feeding, and colostomy management if present.

1. ANORECTAL
MALFORMATION

2. INTRODUCTION
Comprises a wide spectrum of defects involving
distal anus and rectum as well as urogenital
tract.

3. • It involves arrest of rectal
descent resulting in
absence of an anal
opening.
• Occurs during 4th to 16th
week of gestation.

5. INCIDENCE
• Boys are more affected than girls.
• Minor abnormalities occurs in about 1/500 live births
while major abnormalities occur in 1/5000 live
births.

6. RISK FACTORS
• Genetic inheritance
• Family history
• Down syndrome

7. CLASSIFICATION
Anal stenosis Anal
membrane
atresia
Rectal atresia
Anal agenesis
or imperforate
anus

8. 1. Anal stenosis
• Stricture 1 - 4 cm above the
anus.
• Stricture may extends
through the entire length
of anus.

9. Anal membrane atresia
• A persistent anal
membrane produces
obstruction behind which
meconium can be seen.

10. Rectal atresia
• A normal anus is present
but rectum ends as a
blind pouch in the
hollow of the sacrum.

11. Anal agenesis or imperforate anus
• An imperforate anus possibly seen
as a dimple with rectum ending as
a blind pouch some distance above
the anus.
• Accounts for about 80% of
anorectal malformations.

12. • Fistula may
also be
present
between the
rectum and
urogenital
tract.

13. DIAGNOSTIC EVALUATION
Through newborn assessment:
• No anal opening
• NG tube or thermometer cannot be inserted into the
infant’s rectum.
• No history of passage of meconium
• Presence of meconium in urine (rectovaginal fistula)

14. • Abdominal USG
• Intravenouspyleogram (IVP)
• Cystourethrogram
DIAGNOSTIC EVALUATION

15. MANAGEMENT
SURGICAL PROCEDURE:
ANAL STENOSIS:
• Manual dilatation is done by Hegar’s dilators
for increasing the diameter.
ANAL MEMBRANE ATRESIA:
• Incision of membrane or perforation with a
blunt instrument followed by anal dilatation.

16. IMPERFORATE ANUS:
• Two stage surgery is done.
• First stage: creation of a temporary colostomy.
• Second stage: Intestinal repair and colostomy
closure.
MANAGEMENT

17. NURSING MANAGEMENT
PRE OPERATIVE:
• Hold oral feeding as soon as the anomaly is noticed.
• IV fluids
• Measure abdominal girth
• Nasogastric aspiration for gastric decompression.
• Monitor vital signs
• Psychological preparation of family members.

18. POST OPERATIVE
• General post anesthesia care
• IV fluids
• Nasogastric suctioning
• Start oral feeding as the peristalsis begins.
• Care of colostomy.

19. THANK
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