Management of imperforate anus at the Lagos University Teaching Hospital, Nigeria: a review of ten years' experience.

Sixty cases of imperforate anus treated at the Lagos University Teaching Hospital, Nigeria between 1969 and 1979 are reviewed. Late presentation at our hospital was a remarkable feature. Although there were only 18 attempts at Wangensteen-Rice (Wangensteen and Rice 1930) inversion radiograms using all the information available, it was possible to categorize 27 children as having high and 17 as having a low-type imperforate anus. Only 16 of the children with high lesions have had abdominoperineal pull-through procedures with an operative mortality of 31%. Eleven definite procedures for low lesions were carried out in newborn infants. The rest were decompressed either by a colostomy or a congenital fistula and are waiting for definite surgery. One child died before any surgical treatment. Some of the problems related to the outcome of treatment of this disease in our hospital are late presentation, inadequate facilities and shortage of specialized personnel, problems peculiar to a developing country. We suggest an urgent colostomy performed under local anaesthesia as a safe and expedient treatment for babies with obstruction and in whom the presence of a translevator anomaly cannot be immediately verified.