By Ny.

S/m/4 hour

Chief Complain : absence of anus

It has happened since born, 4hours before
admited to Adam Malik Hospital. The baby was
born through sectio cesaria delivery by
Obstetrician. Babys BW:2600 gr, aterm,
meconium(-). He is the second child, no history
of congenital anomaly in the family. History of
ANC by midwife 5 times. Distension (-), Vomiting
(-), Micturition (+) Normal.

General Examination
Sensorium : Alert
HR : 150 x / min
Temp : 36,7 C
RR : 44 x / min
Physical Examination
Head : Conj palp inf anemic (-), sclera
icteric(-)
Thorax I : simetris
P : sonor
A : Vesicular both hemithorax

Abdomen :
I : Simetris, distension (-)
P : supple, defans muscular (-),
tenderness (-)
P : hypertymphani
A : peristaltic (+) increased ?
Anus and Genitalia : midline raphe
(+), fistula (?)

Laboratory Finding
Hb / Ht / L / Plt : 18/ 52,7 / 26,34 / 237.000
Ur / Cr/Alb : 11 / 0,52/3.8
Na / K / Cl : 136 / 4.6 / 112
PT : 23.6
INR : 1.69
aPTT : 42.1
Albumin : 3.8
Random Glusoce Level : 71

Radiology Findings
Baby gram :
Cor, diaphragm was good
Pulmo : bronchovascular shadow was
normal
Distribution of air in bowel was normal
Bones and soft tissues were good

 Working Diagnosis : Anorectal Malformation

Management in Emergency Room
Installation of IV line 260cc/24hours
Installation of OGT
Installation of Urinary Catheter, Came out clear
yellow 10cc
Inj. Antibiotics
Preparation for minimal PSARP

Baby g

Foto Operasi

At the operating theatre :

In GA with buttock position, septic, antiseptic
draping procedure was perform.
Incision on the from the midline raphe, skin,
subcutaneous, anal canal was identified.
Came out meconium.
Anal canal separated from surrounding tissue.
Anal canal attach to the skin to all clockwise.
Busination was perform from No. 8 to 13.
Operation done.

Male Newborn With Anorectal

Malformation
Perineal inspection and urynalisis (wait
24 hour)
Clinical Evidence
(90%)

Perineal Fistula
Bucket handle
Midline raphe fist
ula
Anal stenosis

Questionable

Flat bottom
Meconium in
urine

Colostomy *

Minimal PSARP
NEWBORN
NO COLOSTOMY

4 to 8 weeks:
Rule out
associated
malformation;
Verify normal
growth

PSARP

Cross-table lateral film, prone

position
> 1cm
Bowel
skin
distance

< 1cm
Bowel
skin
distance

Minimal
PSARP
NEWBORN
NO
COLOSTOMY

Female Newborn With Anorectal

Malformation
Perineal inspection (wait 24 hours)
No Fistula
(Appox 5%)

Fistula (Approx.
95%)

Cloaca
Emergen
cy
GU
evaluatio
n

Colostomy &
Vaginostomy
Urinary diversion
(if necessary)

PSARVUP

Vestibular
(or vaginal
)

Colostom
y
*
4 to 8 weeks:
Rule out
associated
malformation;
Verify normal
growth

PSARP

Cutaneus
(perineal)

Cross-table lateral film, prone

position
> 1cm
Bowel
skin
distance

Minimal PSARP
NEWBORN
NO COLOSTOMY

< 1cm
Bowel
skin
distance
4 to 8 weeks:
Rule out
associated
malformation
;
Verify normal
growth

PSARP