title: Delayed presentation of anorectal malformation for definitive surgery.
abstract: OBJECTIVE
  To retrospectively study the outcome of patients with anorectal malformations (ARM) presenting late for definitive procedure.
  
  
  METHODS
  Patients with ARM presenting beyond 5 months of age managed from January 2008 to March 2012 were studied for clinical outcome.
  
  
  RESULTS
  Ages at presentation varied from 5 months to 14 years, seven patients were older than 5 years of age. Of the 36 cases, 5 patients (3 boys and 2 girls) had presented with colostomy done elsewhere. Four patients had high anomalies. Of the 33 girls, 14 had rectovestibular fistula and 9 had anovestibular fistula. Bowel preparation with peglec was used in patients without colostomy. Preoperative retention enemas, laxatives and Hegar dilators were used for 3-11 days before surgery. On table irrigation was required in four. Patients without a covering colostomy were kept nil per oral for 5 days following surgery in prone/lateral position. Two patients had mild post-op wound infection, and were managed with local care.
  
  
  CONCLUSIONS
  Delayed presentation of ARM especially in girls is quite common in developing countries. With proper perioperative care, these cases may be managed successfully with a single stage procedure in most cases. The mature tissue growth with age allows proper tissue dissection and good repair of the perineal body in girls.
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. drshilpas@gmail.com
authors: Shilpa
authors: S
authors: Sharma
authors: Devendra K
authors: DK
authors: Gupta
mesh_terms: D000293:Adolescent; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003125:Colostomy; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012003:Rectal Fistula / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies