Bowel perforation in newborn with anorectal malformation and no fistula at presentation.
PURPOSE
Anorectal malformation (ARM) in newborns with no fistula at presentation resembles intestinal obstruction. The aim of this study is to study the factors associated with bowel perforation in this group of patients.


METHODS
From 2000 to 2012, 106 newborns with ARM were managed in our hospital. Thirty neonates without fistula at presentation were included in this study. Demographic data and the incidence of bowel perforation were studied.


RESULTS
Twenty-nine male and 1 female were included in the study. Five patients were born premature and six patients had low birth weight. Six patients had Down's syndrome and 12 patients had associated anomalies. Cross-table lateral x-ray in prone position was performed from 20 to 24 hours after birth. All operations were performed within 48 hours after birth. One neonate underwent primary anoplasty. Twenty-nine neonates underwent colostomy. Two males developed bowel perforation before surgery (at 33 and 36 hours after birth). Perforation was associated with low birth weight (p=0.034) and was not associated with prematurity (p=0.31), Down's syndrome (p=0.634) or the presence of other associated anomalies (p=0.687).


CONCLUSIONS
In newborns with ARM, bowel perforation can occur within 36 hours after birth. Forty-eight hours of waiting is too long as it risks perforation. In this study, a neonate with low birth weight was trended toward bowel perforation.
['Chan|Kin Wai Edwin|KW|', 'Lee|Kim Hung|KH|', 'Tsui|Siu Yan Bess|SY|', 'Wong|Yuen Shan|YS|', 'Pang|Kit Yi Kristine|KY|', 'Mou|Jennifer Wai Cheung|JW|', 'Tam|Yuk Him|YH|']
D000015:Abnormalities, Multiple D000071056:Anorectal Malformations D001006:Anus, Imperforate D003125:Colostomy D057210:Delayed Diagnosis D003937:Diagnosis, Differential D004314:Down Syndrome D042241:Early Diagnosis D005260:Female D006801:Humans D007230:Infant, Low Birth Weight D007231:Infant, Newborn D007234:Infant, Premature D007235:Infant, Premature, Diseases D007415:Intestinal Obstruction D007416:Intestinal Perforation D008297:Male D011859:Radiography D012189:Retrospective Studies D013997:Time Factors D016896:Treatment Outcome
Perforation Anorectal malformation Fistula