Pattern of Anorectal malformations and early outcomes of management at Moi Teaching and Referral Hospital Eldoret Kenya

Abstract

Objectives: To describe the anatomical sub-types of Anorectal malformations, their management and the early outcome at Moi Teaching and Referral Hospital (MTRH) over a 16 month period. Design: A prospective study. Setting: MTRH, in the neonatal Unit and paediatric surgical wards for the initial capture of patients and initial follow up. The Paediatric Surgical out- patient clinic was used for the subsequent follow ups. Subjects: All infants diagnosed with ARM (Anorectal malformations) at MTRH from November 2011 to April 2013. Main outcome measures: Sub-types of the Anorectal malformations, coexisting abnormalities morbidity and mortality rates. Results: There were 42 participants including 24 (57%) males and 18 (43%) females. Neonates presented at an average age of 4±3, three days and older children presented on average age of 152±118, three days. There were 30 (71%) neonates and 12 (29%) older infants. In males, the predominant sub-type was imperforate anus without a fistula found in ten participants (42% of males). In females, the predominant sub-type was recto-vestibular fistula found in 14 participants (78% of females). Mortality occurred in 13 (31%) participants among them ten (24%) had coexisting abnormalities. The main causes of morbidity were: colostomy complications in four (9.5%); wound infections in one (5%); and wound dehiscence in one (5%). Conclusions: Patients with Anorectal malformations presented late at MTRH. The diagnosis at birth was missed in babies born at home as well as those delivered in health institutions.