This document discusses anorectal malformations (ARM), which are abnormalities of the anus and rectum that occur during gestation between 4-16 weeks. ARM can range from minor to major and include conditions like imperforate anus where the anal opening is absent. The cause is unclear but is likely multifactorial and genetic. Diagnosis involves physical exam and imaging tests. Treatment depends on the specific abnormality but may include surgery to correct the defect. Post-operative care focuses on bowel and skin care to support healing. ARM can impact later life functions but early treatment can help minimize complications.

1. Surendra Sharma
Associate Professor
Amity College of Nursing
Amity University, Haryana

2.  It is the abnormality of the anus & rectum as well
as 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.  > common in boys
 Minor abnormalities - 1 : 500 newborns
 Major abnormalities - 1 : 5000 newborns

4.  Unclear
 Multifactorial, multigenic
 Risk is > for a sibling with a patient
 > risk in Trisomy 21(Down syndrome)
 95% have ARM with fistulas

5.  At 7th - 8th week of embryonic life
 Membrane present between rectum & anus perforates
 Continuous canal is formed
 Note: Anorectal & Geintourinary tract originate from
the embryonic structure

6.  Depending upon gestational age during which the
embryonic development is disrupted & on the level to
which rectal pouch has descended, the anomaly will be
either low (10th – 12th week) or high(4th week)

7.  Fistulas may be present between rectum & vagina,
perineum(female), urinary tract, scrotum in male.

8.  4 types
 Stenosis of anus (stricture at 1 to 4 cm above the anus or the
entire length of anus)
 Anal membrane atresia : obstruction caused by persistant
anal membrane (behind which meconium can be seen)
 Anal agenesis (imperforate anus) anal dimple seen (rectal
pouch ending some distance above the anus & fistulas
present with other organs) - 80% cases

9.  Rectal atresia: normal anus & normal anal pouch but
rectal pouch ending blindly in the hollow of the sacrum

10.  Physical examination
 No anal opening
 Impossible to insert gloved finger or thermometer into infants
rectum
 No meconium stool
 Later abdominal distension
 Passage of meconium in the urine or ribbon stools
 X-ray (inverted position – to force the swallowed air down through
the bowel & placing an opaque object at the anal dimple)

11.  Abdominal USG: associated urinary tract
anomalies

12.  Gastric suction
 Main concern: bowel control, urinary control
& sexual function in later life
 Anal membrane atresia – incise or perforate
membrane with a blunt instrument &
dilatation
 If 1.5 cm distance is present between anal
dimple & blind end - correction through
perineum

13.  Anal stenosis - dilatation of anal stricture
daily until child can readily defecate(may be
for 4 to 6 months)

14.  IV feedings & nasogastric suction to prevent
abdominal distension immediate postoperative period.
 Breast milk or Infant formula to be given when
peristalsis returns
 If anal area involved – to be kept dry & clean
 Diaper should not be used
 Turned frequently & tension on perianal area to be
prevented

15.  If colostomy formed – meticulous skin care is
necessary
 Dressings to be changed frequently
 Collection bag to be applied correctly