Atresia of the anus

An atresia of the anus is a developmental defect that consists in the lack of an anal opening or the blind end of the rectum in the higher parts. It very often appears in newborns. A child with this condition does not give up meconium, and after a few days flatulence and vomiting appear. This type of defect requires surgical treatment.

What is rectal atresia?

Atresia of the anus is a congenital defect, the characteristic feature of which is the absence of an anal opening or its faulty position. It usually affects 1 in 5000 newborns. The incidence of this condition in boys is slightly higher than in girls. This defect occurs most frequently in newborns and its exact causes remain unknown. Some theories speak of improper development of the large intestine early in the uterus (7-8 weeks). Anus atresia in the family is rare.

A child with an overgrown anus does not give up meconium, and after a few days he develops obstruction, flatulence, vomiting, etc.). Sometimes atresia of the anus is associated with the existence of a fistula between the anus and the genitourinary system. Then the child expels green-colored urine through the urethra or vagina. This defect may also be present in Down’s and Patau’s syndromes.

Division of rectal defects

1. high defects – the position of the rectum in the abdominal cavity far from the baby’s skin is characteristic;
2. low defects – the rectum is located close under the skin.

What are the causes of anus atresia?

They are not known. It is known, however, that atresia of the anus can occur together with other defects:

1. nervous system,
2. spinal cord,
3. genitourinary system,
4. heart and vessels,
5. digestive system.

Symptoms of atresia of the anus

Symptoms of rectal atresia are usually noticeable during the first examination of the newborn. It is characteristic that it does not reflect meconium. However, in the event that the disease is not recognized immediately – symptoms appear a little later and indicate obstruction of the digestive tract. Atresia of the anus prevents the contents of the intestines from being excreted. Over time, they begin to accumulate and are exposed to intestinal bacteria, which in turn leads to dangerous symptoms in the form of:

1. abdominal tension
2. abdominal pain,
3. vomiting with fecal content (greenish in color and a characteristic smell; it is digested food content),
4. high temperature,
5. shortness of breath (caused by pressure on the diaphragm by enlarging intestines),
6. intestinal peristalsis disorders,
7. anxiety.

Usually, the symptoms are recognized by a neonatologist in the neonatal unit. However, if parents notice disturbing symptoms after their child is discharged from the hospital, they should immediately consult their GP or neonatologist.

Anus atresia diagnosis

At the stage of pregnancy, atresia of the anus can be detected on the basis of ultrasound examination. Then you can see an increased amount of amniotic fluid or the presence of a cyst in the baby’s abdominal cavity, which may indicate an enlarged intestine.

The diagnosis of rectal atresia requires, first of all, a thorough physical examination of the newborn. In turn, to determine the type of defect, it is necessary to conduct additional tests:

1. general urine test – the diagnosis of meconium may be helpful in determining the presence of a recto-urinary fistula;
2. pelvic radiography – it helps to determine where the intestines are located and whether there are any abnormalities of the spine;
3. abdominal ultrasound – is an examination that helps to find coexisting defects of the urinary system;
4. spinal cord ultrasound – a method recommended for children with suspected spinal defects.

Atresia of the anus – methods of treatment

In children diagnosed with atresia of the anus, the first thing to do is to give up solid foods and connect a drip. Then the patient should be transported to the hospital, to the pediatric surgery department, where a specialist will decide what to do next. The treatment of this ailment is an operative treatment, the choice of which is made by the physician. Possible methods of surgery are:

1. reconstruction of the anus in the correct place – is performed in newborns with a “low” type of defect;
2. colostomy – a procedure that involves removing the large intestine from the abdominal cavity, cutting it and then sewing both ends into the skin of the abdomen. This creates an artificial double-bore anus. In this way, the child is protected against possible complications in the form of intestinal obstruction, enteritis or urinary tract infections. Moreover, thanks to this method it is possible to postpone the actual operation.

Colostomy is also recommended for children with coexisting abnormalities or for toddlers who cannot undergo long-term rectal reconstruction surgery. After the procedure, the child is given antibiotics. Two weeks after the surgery, the anus is dilated. A Hegar extension is used for this purpose. This task is first undertaken by a specialist who then teaches parents how to perform this procedure at home (the activity should be repeated twice a day for several weeks).

Is it possible to recover completely?

The prognosis of this disease depends on the type of the diagnosed defect and other additional disorders. The reconstruction of the anus is considered a success, which enables the stool to be maintained. In the case of “low” rectal defects, the chance of recovery may be as high as 100%, provided that there is no coexistence of recto-urinary fistula. In turn, in the case of “high” defects, it is difficult to determine the prognosis, it is an individual matter.

After treatment, sometimes complications in the form of constipation may occur, so parents should eliminate or limit the following products in the child’s diet:

1. rice,
2. bananas,
3. wheat bread toast.

It’s a good idea to make your child eat more fiber-based foods, such as whole grain bread, fruit and vegetables. However, changing the diet does not always bring satisfactory results, and sometimes the only solution is to give your child laxatives. In turn, in toddlers with a concomitant defect of the urinary system, prophylactic drugs should be given to prevent urinary tract infections.

Important! Children who have undergone rectal operations (up to adulthood) should be systematically monitored.

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