Males are more at risk to have high lesions. The anal opening can be in the
perineum, anywhere along the urethra, bladder neck, or bladder. Meconium staining
along the scrotal raphe suggests a low lesion.
When examining a baby with an anorectal malforation, signs are elicited to see
whether there is a low or high lesion. Signs of a low lesion include well-formed gluteal
muscles, a “bucket handle” skin tag on the area where the anal opening would have
been located, meconium “pearls” along the scrotal raphe.
Associated anomalies are more commonly seen in high lesions). Anorectal
malformations are part of the VACTERL complex. As such, a work-up to rule out
vertebral/rib anomalies, cardiac anomalies, tracheoesophageal fistula/esophageal
atresia, genitourinary anomalies, and limb deformities should be initiated. A tethered
spinal cord may be present. Anorectal malformations can also be part of more involved
dysmorphic anomalies of the lower torso such as sacral regression syndrome, cloacal
anomalies, and cloacal extrophy. These more severe malformations require a
multidisciplinary approach.
Radiologic imaging would at least include ECHOcardiogram, CXR, renal
ultrasound. Further work-up should be dictated by clinical findings.
Management