title: Bowel perforation in newborn with anorectal malformation and no fistula at presentation.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: edwinchan@surgery.cuhk.edu.hk.
authors.forename: Kin Wai Edwin
authors.initials: KW
authors.lastname: Chan
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Siu Yan Bess
authors.initials: SY
authors.lastname: Tsui
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Yuen Shan
authors.initials: YS
authors.lastname: Wong
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Kit Yi Kristine
authors.initials: KY
authors.lastname: Pang
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jennifer Wai Cheung
authors.initials: JW
authors.lastname: Mou
authors.affiliation: Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
mesh_terms: D000015:Abnormalities, Multiple; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications* / Q000601:surgery; D003125:Colostomy; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007415:Intestinal Obstruction / Q000175:diagnosis; D007416:Intestinal Perforation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anorectal malformation; Fistula; Perforation