LETTER TO THE EDITOR
Year : 2011 | Volume
: 55 | Issue : 2 | Page : 135--136
Delayed presentation of anorectal malformations: Need of community awareness
Kirtikumar J Rathod1, Santosh Mahalik1, Monika Bawa2, Ram Samujh3, K.L N Rao4,
1 Senior Registrar, Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
2 Senior Research Associate, Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
3 Additional Professor, Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
4 Professor and Head of Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Kirtikumar J Rathod
Senior Registrar, Department of Pediatric Surgery, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh
|How to cite this article:|
Rathod KJ, Mahalik S, Bawa M, Samujh R, Rao KN. Delayed presentation of anorectal malformations: Need of community awareness.Indian J Public Health 2011;55:135-136
|How to cite this URL:|
Rathod KJ, Mahalik S, Bawa M, Samujh R, Rao KN. Delayed presentation of anorectal malformations: Need of community awareness. Indian J Public Health [serial online] 2011 [cited 2021 Mar 3 ];55:135-136
Available from: https://www.ijph.in/text.asp?2011/55/2/135/85253
Anorectal malformations (ARMs) are common congenital malformations with an average incidence of 1 in 5000 and are surgically correctable with a good prognosis. Diagnosis of ARM should be established by careful perineal examination during routine neonatal examination within 24 hr of birth. The advances in health care system in developed countries have made unrepaired ARMs in late childhood extremely rare.  The situation in the developing countries like India is different where a significant numbers of deliveries take place at home assisted by nonmedical or trained birth attendants (TBAs). TBAs have traditionally been assisting the women during childbirth for centuries in India. TBAs can contribute positively for clean delivery and clean cord care for the prevention of newborn infections, thermal protection, early and exclusive breastfeeding, initiation of breathing, resuscitation, and eye care, and immunization, recognition of illness and at risk newborn referral or management. Also, take care of the preterm and/or low birth weight newborn.  Proper training of TBAs are required for diagnosis of ARM otherwise, ARMs could be easily missed and the patient present later during infancy or even childhood, especially when the child is not suffering from severe constipation.
Delay in diagnosis may lead to serious early complications like abdominal distension, vomiting, dehydration, intestinal perforation, respiratory distress, sepsis, failure to thrive and finally death. , Late presentation may be associated with development of megarectum, which may require a defunctioning colostomy for decompression prior to definite surgical correction. These types of patients then require an additional surgery for closure of stoma. 
We recently came across two infants who presented to us with features of sub-acute intestinal obstruction and severe constipation and later found to have low ARM. The first case is a 9 month old male child, delivered at home by a TBA. The child was breast fed till 6 months of age and apparently passing very small amount of stool but after weaning the child became constipated and presented to us at ninth month. On examination, the child has absent anal opening and an anocutaneous fistula was present, through which the child was passing small amount of stool. An anoplasty was done and in the postoperative the child recovered well. The second case was an 18 month old male child, delivered at home by a TBA. The child was breast fed till 1 year of age followed by weaning. The child had constipation from neonatal period and was passing thin caliber small amount of stool but the parents never seek hospital attendance. At the age of 14 months shown to some local practitioner and was advised laxatives. The child was passing small amounts of stool on laxatives and since last few days the child had persistent abdominal distension and non passage of stool. When presented to us, the child was dehydrated, abdomen was mildly distended and on perineal examination anal opening was absent. Anocutaneous fistula with bucket handle deformity was found. Anoplasty was done and the child recovered well.
From these cases, this is apparent that TBA in our country are not well trained for detecting congenital anomalies especially anorectal malformation which can be detected on simple inspection of perineum. Lack of literacy and lack of awareness in parents contribute for delayed presentation of this type of low ARM. It is true that though health care system in India is becoming better with each year, still many deliveries are being conducted at home by "dai" or not properly trained so called TBAs. This attribute to the fact that many places in India are still devoid of basic health care facilities like hospital delivery and we should focus more intensively for real progress in basic health care, health awareness and most importantly literacy.
So the message which we want to convey from this letter is that, all the TBA should be properly trained to detect all the apparent congenital anomalies after the delivery of baby. A simple inspection of the baby's perineum just to see the presence of anal opening in its correct position can help in diagnosing this dreadful anomaly. A note can be made on passage of fecal matter from abnormal opening e.g, vulva or vaginal in case of female babies and from the urethra in case of males babies.
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|3||Lindley RM, Shawis RN, Roberts JP. Delays in the diagnosis of anorectal malformations are common and significantly increase serious early complications. Acta Paediatr 2006;95:364-8.|
|4||Haider N, Fischer R. Mortality and morbidity associated with late diagnosis of anorectal malformations in children. Surgeon 2007;5:327-30.|