Delayed presentation of anorectal malformations: the possible associated morbidity and mortality.

AIM: Anorectal malformations (ARMs) are one of the most common congenital anomalies dealt by pediatric surgeons with reported incidence of approximately 1 in 5,000 live births. The majority of patients usually presents during the neonatal period. However a significant number of patients report later during infancy or even late childhood. Such delayed presentation may affect the surgical management and contribute to functional and psychological problems for both babies and their parents. The aim of this study is to highlight the frequency of this problem, cause of delayed presentation, and how this delayed presentation of ARM contributes to morbidity and mortality. PATIENTS AND METHODS: During the 3-year study period, 104 cases with ARM (74 males and 30 females) were presented to pediatric surgery unit in Assiut university children's hospital. Delayed presentation means that the child came after the first 48 h or after 3 months of age in case of low ARM in females.
RESULTS: Out of 104 cases, 20 fulfil the criteria of delayed presentation (11 females and 9 males). Their age at presentation ranged from 4 days to 14 years. Fourteen classified as low ARM (6 male and 8 female), whereas six classified as high ARM (3 male and 3 female). The causes of delayed presentation were delayed detection, wrong advice to the parents, inadequate treatment offered, and social causes. The associated morbidities encountered were chronic constipation, mega rectum, and unnecessary colostomy. Two mortalities were encountered; both were males presented on days 4 and 14 after birth.
CONCLUSIONS: Delayed ARMs is not uncommon. Every neonate should be carefully examined and screened for such anomaly to avoid the possible morbidity and mortality which are directly related to this delayed presentation.