An Experience with Anorectal Malformations (ARM) at a Tertiary Care Centre of Rawalpindi, Pakistan

Abstract

Objective : Early diagnosis of Anorectal malformation and VACTERL association is essential for treating newborns with these conditions. We aim to assess, clinical data of patients with Anorectal malformation (ARM), maternal risk factors associated with ARM, and other congenital anomalies in pediatric patients presenting with Anorectal malformation (ARM).

Study Design : Cross-sectional study

Place and Duration of Study : Pediatric Surgery Department of Holy Family Hospital from January 2021 to August 2022

Material and methods : 117 Patients diagnosed with anorectal malformation were included. Socio-demographic variables and details of selected maternal characteristics were obtained from history of the patient. Patients were examined for the presence of VACTERL anomalies. SPSS Version 21 was used for descriptive analysis. Chi square test was applied to see the association.

Results:117 pediatric patients (9.75%) with anorectal abnormalities were evaluated out of a total of 1200 pediatric patients in our tertiary care center. 71 were males (60.7%) and 46(39.3%) were females. Out of 117, only 5(4.3%) were pre-term and the other 112(95.7%) were term. Family history of ARM was found only in 7(6%) patients. Regarding associated anomalies found in patients with ARM, Recto-urethral fistula (34.57%) was the most common type followed by Perineal fistula (21.49%) and Recto-vestibular fistula (21.49%). Vertebral/spinal anomalies were found in 18(15.38%) patients, Cardiac anomalies were present in 20(17.09%) infants, 3(2.56%) patients were born with TEF, 30 (25.6%) patients had renal anomalies, and Limb anomalies were found in 6(5.12%) patients. Out of 117 patients with ARM, 13(11.11%) ultimately passed away. VACTERL (vertebral, anal atresia, cardiac, tracheo-esophageal fistula, renal, and limb) anomalies were found in 12 (92.3%) of these expired patients. Regarding maternal characteristics, Gestational diabetes mellitus was the most common disease found in mothers (50%) followed by pre eclampsia (37.5%) and eclampsia (12.5%). Supplementation including folic acid, iron and calcium was taken by 101(86.32%) mothers.

Conclusion: Majority of the patients were born at Term, were males, and belonged to the lower-socioeconomic class. Recto-urethral fistula was the most common anomaly found in patients with ARM. Among the patients with ARMs who passed away, vast majority of them had associated VACTERL (vertebral, anal atresia, cardiac, tracheo-esophageal fistula, renal, and limb) anomalies. Many of the mothers of these patients gave history of having Gestational diabetes mellitus and Pre-eclampsia.

Key words: imperforate anus, gastroenterology, pediatrics, epidemiology, congenital anomalies, anorectal malformation