🩺 Section 392.1: Anorectal Malformations

Nelson Textbook of Pediatrics 22nd Edition — Anorectal malformations (ARM) occur in 1 in 3000 live births. Low lesions (perineal fistula) → primary anoplasty, excellent prognosis. High lesions (rectourethral, rectovesical, cloaca) → protective colostomy then posterior sagittal anorectoplasty (PSARP). Associated with VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb) and Currarino triad (sacral agenesis, presacral mass, ARM).

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📋 30 Clinical Scenarios — Anorectal Malformations

📇 High‑Yield Review Cards (Anorectal Malformations)

🩺 Clinical Presentations: ARM by Type

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of ARM

🔑 Key Principles — Anorectal Malformations (Nelson 392.1)
• Low lesions: Perineal fistula (meconium visible on perineum). Primary anoplasty in newborn period. Good prognosis for continence.
• High lesions (males): Rectourethral fistula (bulbar or prostatic). No perineal opening. Protective colostomy, then PSARP at 3-6 months.
• High lesions (females): Rectovestibular fistula (most common) or cloaca (single perineal orifice). Colostomy + PSARP.
• Associated anomalies: VACTERL (evaluate spine, heart, trachea, esophagus, kidneys, limbs). Sacral anomalies predict continence.
• Currarino triad: Sacral agenesis, presacral mass (teratoma, meningocele), anorectal malformation. Autosomal dominant (MNX1 gene).
• Postoperative: Anal dilatations to prevent stricture. Bowel management program for soiling.

    ⚡ Reflex Prompts — ARM Clinical Decisions

    📖 Anorectal Malformations — Core Summary (Nelson 392.1)