Congenital Malformation of the Anus and Rectum in Children in Calabar, Nigeria

Between 1992 and 20012, 54 infants were attended to at the University of Calabar Teaching Hospital, the only tertiary referral center for paediatric surgery in Southeastern Nigeria. There was a male: female ratio of 1:1.5 and majority of the infants (75%) were born to teenage mothers of low socio-economic status. The anomalies were classified using Ladd's method: type I-18.5% of patients, type 11-25.9%, type III 48.1% and type IV – 7.5% of patients. The incidence of associated multisystemic anomalies was 9%. A majority (79.6%) of the patients presented late in hospital. Abdominal distention (100% of patients) non-passage of meconium (76%) and constipation (70% were the leading symptoms). Perineals cutdown was carried out on patients with types I and II lesion; palliative colostomyu prior to definitive abdominal perineal pull through was the approach in infants with Ladds types III and IV. Postoperative complications encountered were faecal incontinence, anal stenosis, constipation and colostomy prolapse. Eleven of the patients with colostomy defected from follow up appointments and were later confirmed dead. Unfortunately, ignorance and poverty appeared to have played a significant negative role in the outcome of infants with anorectal anomaly in Calabar. Health education and improvement in the socio-economic status of the populace may assist in improving the outcome of patients. The study also demonstrated that the anatomical pattern of anorectal dysgenesis in southeastern Nigeria is in keeping with global experience. Mary Slessor Journal of Medicine Vol.3(2) 2003: 25-2