Abstract

Anorectal Malformations are a spectrum of clinical presentations of an abnormal
termination of the anorectum and are known to occasionally occur with anomalies of other
organ systems commonly referred to as the VACTERL (Vertebral, Anorectal ,Cardiac ,
Tracheoesophageal, Renal, Limb) association. These co-existing anomalies contribute to
factors associated with increased morbidity and mortality1,2.
This study set out to document the spectrum of associated anomalies found in patients with
Anorectal malformations presenting to the Paediatric Surgery unit of the Lagos State
University Teaching Hospital , (LASUTH) Ikeja, Lagos, Nigeria.
This was a prospective cross sectional descriptive study of old and new (consecutive)
patients with Anorectal Malformations presenting at the Paediatric Surgery unit of the Lagos
State University Teaching Hospital (LASUTH), from May 2010 to July 2011. Both male and
female patients with all varieties of anorectal malformations , aged 10years and below were
included, as well as those referred to our centre after initial colostomy in the neonatal period
but awaiting definitive management . Non-consenting patients were excluded .The study
was approved by the Research Ethics committee of the institution and informed consent was
obtained from the parents/guardians of the participating patients. All the patients were
examined thoroughly after a detailed history was taken. Particular attention was paid to the
perineum which was examined in good light.
Further clinical examination was carried out to identify the presence or otherwise of
associated anomalies – VACTERL, these were further evaluated by Lumbosacral
radiographs in the anteroposterior and lateral projections, abdominal ultrasonography and 2-
D Echocardiography (where indicated). Micturating Cystourethrogram was done in some
patients.
Findings as well as demographic data captured were recorded in Proformas.
Data was entered into the Microsoft Excel spreadsheet and exported into the Statistical
Package for Social Sciences Software (SPSS) version 16.0 .
Descriptive and inferential statistics were applied in the course of analysis. Proportions and
percentages were calculated for categorical variables.
Minimum, maximum, and mean + standard deviation were appropriately applied in the
course of analysis.
A total of 44 patients with Anorectal malformations were seen in the Paediatric surgery
unit at LASUTH during the 15-month study period. This constituted 1.56% of all
paediatric surgery patients seen within that period. The minimum age was 1 day old, while
the maximum was 8 years. The mean age + SD was 7.56 + 16.05 months. Thirty one
(70.5%) of the children were less than 1 year old, Twelve (27.3%) were 1 – 5 years, while
only one child (2.3%) was older than 5 years of age.
Twenty-one (47.7%) were male and twenty-three (52.3%) were female. More male
patients (90.5%) presented via the Children Emergency, compared to the females
(17.4%). More female patients (82.6%) were referred from various health facilities.
Anorectal agenesis with Rectovestibular fistula was the most frequent anomaly seen.
Vertebral anomalies were noted in 11 patients (25%). Bifid vertebra was present in 9
patients (20.5%).. Of the 9 patients with bifid vertebrae ,6 had other associated anomalies
which included hemivertebrae in 2 patients (4.5%), fusion of the fourth and fifth lumbar
vertebrae (L4 & L5) , Right tibial hemimelia with post-axial polydactyly of the left foot,
glandular diphallus with crossed renal ectopia , Bilateral Vesicoureteric reflux and
cardiac anomalies . Lumbarization of the first sacral vertebra (S1) was noted in 2 patients
who did not have other associated anomalies. (Table I, II,FIG 1, FIG 2,FIG 3 ).
Other urogenital abnormalities noted were undescended testis and coronal hypospadias.
Cardiac anomalies were noted in a total of 4 patients (9.1%). (Table II )
OBJECTIVE/PURPOSE
PATIENTS AND METHODS
RESULTS