Open AccessPitfalls and technical errors in the first approach to neonates with anorectal malformations in a non-specialist context: can we do any better? A review from three Eastern African Centres
Author(s) -
Alessandro Calisti,
Faisal Abdelgalil Nugud,
Kibreab Belay,
Agnes Mlawa,
Pierluigi Lelli Chiesa
Publication year - 2021
Publication title -
african health sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.391
H-Index - 44
eISSN - 1729-0503
pISSN - 1680-6905
DOI - 10.4314/ahs.v21i3.45
Subject(s) - medicine , referral , context (archaeology) , colostomy , obstructed labour , pediatrics , sacrum , tertiary referral centre , demographics , surgery , general surgery , family medicine , pregnancy , paleontology , genetics , demography , sociology , caesarean section , biology
In sub-Saharan Africa, Anorectal malformations (ARM) are the most frequent cause of neonatal obstruc- tion. Referral to a Pediatric Surgeon is frequently delayed. The first treatment is often delivered at not specialist level and mismanagement may result.
Aim: To study ARM patients referred beyond neonatal period and managed at a non-specialist level.
Materials and Methods: One hundred and thirty patients were included (M/F ratio 63/67) among 144 admitted to three Eastern African Hospitals with Pediatric Surgical facilities. Demographics, type of anomaly, delay on referral, previous man- agement, most commonly observed errors are reported.
Results: The Mean age at referral was 23 months (range five weeks – 23 years). Colostomy was the most frequent surgery (92 cases). Stomas often did not follow the recommended criteria. Ten per cent were not on the sigmoid, and 35% were not divided. "Loop" or "double-barrel" colostomies did not exclude the distal loop. Inverted (10,5%), prolapsed stomas (7,5%), short distal loop (16%) were observed. Twenty-four cases (26%) needed redo. Primary perineal exploration in eight patients resulted in incontinence.
Conclusions: Investments on training practitioners, acting at District/Rural level, and closer links with tertiary centres are recommended to avoid ARM mismanagement and delayed referral to a Specialist.
Keywords: Ano rectal malformations; neonate; low resources context.