Anorectal malformation

MSN

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.

3. CLASSIFICATION With a visible abnormal opening of the bowel: Anal stenosis Anoperineal fistula Anovestiular fistula in female

4. 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.

5. 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.

6. 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.

7. 2. With an invisible but manifested opening of the bowel: Rectovaginal fistula in female Rectourethral fistula in male Rectovesicular fistula

8. 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.

9. 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.

10. 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.

11. 3. No manifested opening of the bowel: Persistent anal membranes Rectal atresia

12. 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.

13. 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.

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

15. MANAGEMENT The reconstructive surgery is done to correct or repair the congenital malformations. It depends u p on the ty p e 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.

16. 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.

17. UMBILICAL MALFORMATIONS

18. Abnormalities related to vitello -intestinal duct Umbilical hernia Examphalos and gastroschisis

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.