Anorectal malformations at University Teaching Hospital of Butare in Rwanda: A review of 46 operative cases

Background: Anorectal malformations (ARM) are comprised of a wide spectrum of disease that involves congenital anomalies of the anus and rectum, as well as the urinary and genital tracts. They occur in approximately 1 in 5000 live births and affect males more than females. They may present as a single or as a combination of abnormalities. Survival and prognosis of anorectal malformations depends upon the severity and number of the associated anomalies. This study was aimed at establishing the incidence, types of ARM, associated anomalies and outcome of surgery among children with anorectal malformations seen at University Teaching Hospital of Butare in Rwanda.Methods: A descriptive retrospective study was carried out on 46 children with ARM admitted to Paediatric and/or surgical departments of Butare University Teaching hospital and operated between 1st May 2002 and 31st May 2007. Information regarding age at presentation, sex, type of abnormality, associated congenital anomalies, operative findings, outcome of surgery was extracted from the patients’ clinical records and operation registers. Data was analyzed using Epidata and SPSS 11.3 computer programs.Results: Of the 2264 patients operated on for gastrointestinal conditions during the period under review, 648 (28.6%) of them were children of whom 46 (2% of all operated digestive pathologies or 7% of digestive pathologies operated in children) were for anorectal malformations. All these 46 were included in the study. 63 % were male and 37% female. The majority of them consulted in the first week of life (56.5%) and 43.5% have been operated in that first week. 60.9% of our cases had low ARM (LARM), 26.1% had intermediate ARM (IARM) and the rest (13%) had high ARM (HARM). Associated anomalies were seen in 77.4% of patients. The major associated anomalies consisted of fistulas (47.3%), gastrointestinal malformations (17.2%), skeletal malformations (10.75%), and cardiac (2.15%). The overall survival rate was 87%. It was 92.85% for LARM, 100% for IARM and 33.3% for HARM with a significant statistical difference (p=0.011). The survival rate was 91.3% and 90.5% among those who underwent colostomy and anoplasty as first intervention respectively.Conclusion: Anorectal malformations are common in children’s surgical pathologies, the incidence being in favour of LARM. The survival depends upon the type of ARM, the treatment and the severity of associated anomalies. All children with ARM merit a meticulous search for associated anomalies in order to optimize the management