Imperforate anus-consist of atresia of the anus, with the rectum ending in a blind pouch.

‡ Imperforate anus is congenital (present from birth) defect in which the opening to the anus is missing or blocked. The anus is the opening to the rectum through which stools leave the body.

‡ Causes, incidence, and risk factors Imperforate anus may occur in several forms. The rectum may end in a blind pouch that does not connect with the colon. Or, it may have openings to the urethra, bladder, base of penis or scrotum in boys, or vagina in girls. A condition of stenosis (narrowing) of the anus or absence of the anus may be present. ‡ The problem is caused by abnormal development of the fetus, and many forms of imperforate anus are associated with other birth defects. It is a relatively common condition that occurs in about 1 out of 5,000 infants.

7th week of intrauterine life upper bowel elongates to pouch combine pouch invaginating from perineum bowel section meet membranes absorbed

bowel is patent


‡ Condition is diagnosed during the newborn examination with: ‡ -radiography ‡ -ultrasound or CT use to determine the level of the lesions and associated anomalies.
*Urine test-to examine the presence of meconium.

Symptoms include: -failure to pass meconium stool -absence of anorectal canal -presence of anal membrane -external fistula to the perineum

1. Anal stenosis is treated with repeated dilation. 2. All other defects require surgical intervention. 3. High defects may require a colostomy and bowel pull-through procedure.

1. Determine anal patency if meconium is not passed in the first 24 hour after birth. 2. Assess for other GI or genitourinary anomalies. 3.Report any skin dimples or the presence of the stool I the urine or vagina.

4. Assess for other GI or genitourinary anomalies. 5. Facilitate bonding.

6. Provide appropriate postoperative care, including care of colostomy.

‡ NURSING MANAGEMENT AFTER SURGERY ‡ Take axillary or tympanic temperature rather than rectal temperature to avoid loosening a suture. ‡ Infants may be given a stool softener daily to keep the stool from becoming hard and tearing the healing suture line. ‡ Placing a diaper, the infant maybe helpful so bowel movements can be cleanse away. ‡ A side lying position is best.

1. Teach parents colostomy care. 2. Demonstrate anal dilatation( use only prescribed dilator, insert no more than 12cm, and use a water-soluble lubricant. 3. Refer parents for counseling and support.

‡ Many children with anorectal malformations require medications for various reasons. Beyond perioperative medications, maintenance medications often include urinary antibiotic prophylaxis or treatment and/or laxatives. Common laxatives include senna products, milk of magnesia, and propylene glycol solutions (eg, MiraLax, GlycoLax).

‡ Urinary prophylaxis is used to mitigate the risk of urinary infection and urosepsis in children with risk factors for urinary infection such as urinary fistula, vesicoureteral reflux, or continent diversion. Common agents include oral amoxicillin, oral trimethoprim/sulfamethoxazole, and gentamicin bladder irrigations.

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REFERENCES: Maternal Child Health Nursing,Vol.1 Maternal Child health Nursing, evolve Modern Medical Guide,Shryock

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