patient is kept NPO. The most important part of therapy is frequent rectal irrigations to
evacuate the colonic stool burden.
Obstructive Symptoms: Anastomoses can tighten as scars mature. Parents are taught
to do dilations for a few months after surgery.
X. ANORECTAL MALFORATIONS (IMPERFORATE ANUS)
Anorectal malfomations occur in 1 in 5,000 live births, occurring more commonly
in males. There are no known association with maternal age, parity, race.
Lesions classified as low- or high-type imperforate anus based on position of end
of rectum relative to the puborectalis muscle or levator sling.
Anorectal malforations are part of the VACTERL association. Work-up for the
other components of VACTERL should be sought out.
Clinical Presentation
On physical exam, the lack of a normal anal opening is confirmed by the inability
to insert a rectal thermometer. An anal opening that exists anterior to an imaginary line
drawn between the two ischial tuberosities is anteriorly displaced.
Females more commonly have a low variant. The most common anomaly seen
in a girl is a rectovestibular fistula, where the anal opening lies just inferior to the vaginal
opening. The rectal opening can be seen on the perineum as well. Higher lesions (to
the bladder neck and bladder) can exist, but occur less frequently.