MEDICAL UPDATE
Imperforate anus Imperforate anus is one of the most common correctable congenital anomalies seen by pediatric surgeons. Approximately 25 to 30 children are treated for some form of imperforate anus at Children's Medical Center of Dallas each year, so an understanding of the long-term problems these children face is important for all pediatricians.
Imperforate anus is part of the VACTERL (Vertebral, Anorectal, Cardiac, TracheoEsophageal, Renal, Limb) Association of congenital anomalies. It is equally common in boys and girls, although boys are more likely to have high lesions, the rectum ends above the sphincter muscle complex, and girls are much more likely to have low lesions, the rectum traverses most of the sphincter muscle complex before ending.
Following repair of high imperforate anus, fecal incontinence may develop because of poor sphincter musculature or abnormal innervation to the sphincter muscle. An aggressive bowel management program may allow "social continence" but surgical options to prevent soiling, such as an ACE (Antegrade Continent Enema) procedure may be necessary when nonoperative methods are unsuccessful in controlling fecal incontinence. Children with low imperforate anus may have significant constipation that is usually responsive to laxatives and dietary changes to prevent firm stools.
All children with imperforate anus need screening for urinary tract anomalies and spinal cord anomalies, both of which occur in approximately two-thirds of children with a high lesion and one-third of those with a low lesion. Although these children should have been screened for these associated anomalies within the first year of life, some may present to the pediatrician later in life with problems related to these anomalies that were previously unrecognized. | |
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