If the child has a distended abdomen, gastric decompression should be initiated.
A female with a low lesion (rectoperineal fistula or vestibular fistula) through which
meconium is freely expressed may be initially managed with daily dilations through the
perineum. An anorectoplasty with or without a diverting colostomy may be formed 1- 3
months later, when the sphincter muscle complex is mature. A male with a
rectoperineal fistula within the anal complex may undergo an anoplasty, usually without
the need for a diverting colostomy. If a child male or female) has a high lesion, a
colostomy and a mucus fistula is performed in the newborn period, and the definite
repair is performed months later.
Complications
Early complications are related to wound and colostomy issues. In the newborn
population, stomas can have up to a 25-30% incidence of complication such as
prolapse, retraction, and peristomal complications. Late complications are typically
related to the lesions. Low ARM patients have an excellent chance at having
continence, but are likely to have problems with constipation. High ARM patients have
significant problems with continence and may require life-long measures (such as
antegrade enemas) to achieve social continence.