Anorectal anomalies in Ilorin, Nigeria: a 10-year review

Abstract

Background: The treatment of anorectal malformations has been a difficult challenge for surgeons and there is may be a need to modify management in the light of new developments.


Method: Forty-five patients admitted with anorectal malformations from January 1991 to December 2000 were retrospectively studied.


Results: There were 26 males and 19 females. Twenty-one (80.8%) males presented within three days of birth with lower large bowel obstruction. Only 7 (36.8%) of the females presented within the first week with abnormal anal orifices. Associated anomalies occurred in 12 (26.7%) patients. Fifteen patients (33.3%) had high type of anomalies, 14 (31.1%) intermediate, and 11 (24.4%) low type. Nineteen males (73% of males), and 11 females (60% of females) had initial diverting colostomies. Only 8 males (30.8% of the males) and 9 females (47% of the females) had definitive operations and eventual colostomy closure. Nine males died in the neonatal period, 2 discharged against medical advice, 2 were lost to follow-up after attending the clinic with colostomy for over a year, 4 were awaiting definitive operation at the time of the review. One female died after neonatal colostomy, 2 refused colostomy, 4 were lost to follow-up (3 with colostomy, 1 without colostomy) 2 were referred to other hospitals.


Conclusion: Colostomy is socially unacceptable in many third world countries. Colostomy related morbidity and mortality are high. Preliminary colostomy may be unnecessary in most females and certain categories of males. Definitive operations should be done early so that patients carry colostomy for as short a period as possible.


Key Words: Anorectal malformations, posterior sagittal anorectoplasty, colostomy


Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 148-151