Management of anorectal malformations in Dakar: a study of 84 cases

The aim of this retrospective study is to assess the management ofanorectal malformations (ARM) in our institution from January1997 to January 2002. We collected 84 files of children aged 1 dayto 7 years (mean 4.4 months). Patients presented with occlusivesyndromes, meconiuria, and stools emissions by the vulva orthrough ectopic sinuses, either perineal or located at the anus site.Anorectal malformations were classified into the following groupsby clinical and radiological workup:- ARM without fistula (28 cases),- ARM with anal stenosis (2 cases),- ARM with cutaneous (20 cases), genital (19 cases) or urinary (3cases), fistulas.Seventeen (17) children presented associated malformations.Twenty-two (22) children underwent a proctoplasty. A transmuscularpull-through was performed on eight (8) children. Thirty-three(33) had a colostomy before the pull-through.Results were assessed after an average follow- up time of fourteen(14) months. We recorded 3 therapeutical failures out of a group of10 children who were evaluated for continence. There were alsothree mucous ectropions and three anal stenosis. Sixteen (16) childrendied, including twelve (12) after pull-through and four (4) aftercolostomy. This high morbidity and mortality was associated mostlywith high and intermediate anorectal malformations.