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Delayed diagnosis of anorectal malformations in neonates.
ANZ J Surg. 2019 10; 89(10):1253-1255.AJ

Abstract

BACKGROUND

Anorectal malformations (ARM) are common congenital abnormalities of the terminal hindgut. Ideally, ARM should be diagnosed at, or shortly following, birth by careful physical examination of the perineum. Delayed diagnosis has been implicated as a risk factor for complications, including intestinal perforation. This study aimed to determine the rate of delayed diagnosis and associated intestinal perforation in ARM.

METHODS

A retrospective review was performed for all ARM patients managed at The Royal Children's Hospital over a 16-year period (2000-2015). Data collected included ARM type, timing of diagnosis and complications. Delayed diagnosis was defined as being at more than 24 h of age.

RESULTS

A total of 243 ARM patients (male 146/243, 60%) were included. The most frequent ARM types were perineal fistula (83/243, 34%) and rectovestibular fistula (40/243, 16%). Diagnosis was delayed beyond 24 h of age in 92 of 243 (38%) patients. The ARM type most commonly delayed in diagnosis was perineal fistula (37/83, 45%). Two patients in whom diagnosis was delayed suffered an intestinal perforation.

CONCLUSION

Delayed diagnosis in ARM patients remains a common, and potentially fatal, occurrence. Improved assessment of newborns is required to ensure timely diagnosis of ARM, and avoidance of complications associated with delayed diagnosis.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Kruger P
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia. Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Teague WJ
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia. Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
Khanal R
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia. Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Hutson JM
Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
King SK
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia. Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia.

MeSH

Anorectal MalformationsAustraliaDelayed DiagnosisFemaleFistulaHumansIncidenceInfant, NewbornIntestinal PerforationMalePerineumPhysical ExaminationRectal FistulaRetrospective StudiesRisk Factors

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31450268

Citation

Kruger, Paul, et al. "Delayed Diagnosis of Anorectal Malformations in Neonates." ANZ Journal of Surgery, vol. 89, no. 10, 2019, pp. 1253-1255.
Kruger P, Teague WJ, Khanal R, et al. Delayed diagnosis of anorectal malformations in neonates. ANZ J Surg. 2019;89(10):1253-1255.
Kruger, P., Teague, W. J., Khanal, R., Hutson, J. M., & King, S. K. (2019). Delayed diagnosis of anorectal malformations in neonates. ANZ Journal of Surgery, 89(10), 1253-1255. https://doi.org/10.1111/ans.15374
Kruger P, et al. Delayed Diagnosis of Anorectal Malformations in Neonates. ANZ J Surg. 2019;89(10):1253-1255. PubMed PMID: 31450268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed diagnosis of anorectal malformations in neonates. AU - Kruger,Paul, AU - Teague,Warwick J, AU - Khanal,Rija, AU - Hutson,John M, AU - King,Sebastian K, Y1 - 2019/08/26/ PY - 2018/11/17/received PY - 2019/05/29/revised PY - 2019/06/22/accepted PY - 2019/8/27/pubmed PY - 2020/9/23/medline PY - 2019/8/27/entrez KW - anorectal malformation KW - delayed KW - neonate KW - perforation SP - 1253 EP - 1255 JF - ANZ journal of surgery JO - ANZ J Surg VL - 89 IS - 10 N2 - BACKGROUND: Anorectal malformations (ARM) are common congenital abnormalities of the terminal hindgut. Ideally, ARM should be diagnosed at, or shortly following, birth by careful physical examination of the perineum. Delayed diagnosis has been implicated as a risk factor for complications, including intestinal perforation. This study aimed to determine the rate of delayed diagnosis and associated intestinal perforation in ARM. METHODS: A retrospective review was performed for all ARM patients managed at The Royal Children's Hospital over a 16-year period (2000-2015). Data collected included ARM type, timing of diagnosis and complications. Delayed diagnosis was defined as being at more than 24 h of age. RESULTS: A total of 243 ARM patients (male 146/243, 60%) were included. The most frequent ARM types were perineal fistula (83/243, 34%) and rectovestibular fistula (40/243, 16%). Diagnosis was delayed beyond 24 h of age in 92 of 243 (38%) patients. The ARM type most commonly delayed in diagnosis was perineal fistula (37/83, 45%). Two patients in whom diagnosis was delayed suffered an intestinal perforation. CONCLUSION: Delayed diagnosis in ARM patients remains a common, and potentially fatal, occurrence. Improved assessment of newborns is required to ensure timely diagnosis of ARM, and avoidance of complications associated with delayed diagnosis. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/31450268/Delayed_diagnosis_of_anorectal_malformations_in_neonates_ DB - PRIME DP - Unbound Medicine ER -