Anorectal malformation

Anorectal malformation describes a congenital condition in which the anus is not properly formed. The anal opening is either too small and in the wrong place (so-called fistula) or no anal opening is visible. The anorectal malformation can be present in isolation or in combination with diseases of the kidneys, heart, oesophagus or other organs (so-called VACTERL association).

Newborns either have difficulty defecating through an opening that is too small and incorrectly positioned, or they are unable to defecate at all due to a missing opening.

The diagnosis is made by the paediatric surgeon who will examine your child on the first day of life. If it is an anorectal malformation, examinations of the heart (echocardiography), an ultrasound of the abdomen and an examination of the urine and spine are carried out to rule out concomitant diseases.

If your child has an incorrectly positioned anal opening, it is often possible for your child to defecate regularly with the help of a special calibrating rod (so-called Hegar pen), which is inserted into the opening once a day. In this case, the actual operation is planned at around three months of age.

If your child does not have an anal opening, an artificial anus must be temporarily inserted in the first few days of life. During the first three months of life, your child will defecate via the artificial anus.

The actual corrective surgery is performed in both cases at around three months of age. The anus is sutured into the correct position in the centre of the sphincter complex. If an artificial anus is present, this is moved back during the same anaesthetic.

Your child will then be monitored and checked by our team at regular intervals over several years.

Hospitalisation in the neonatal period lasts approximately one to two weeks. After the corrective surgery at around three months of age, your child will be hospitalised for another five to seven days.

The prognosis for later faecal continence depends mainly on the type of anorectal malformation your child has. Depending on the severity, the continence rate with correctly performed corrective surgery varies between approx. 55 % and
100 %.

• Hirschsprung Disease and Anorectal Malformations - An Uncommon Association. Journal of Pediatric Surgery 2020 May 16 Vuille-dit-Bille RN, De la Torre L, Peña A, Bischoff A.
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