Paediatric Surgery of a 1-year-old boy for Anorectal Malformation

When a 1-year-old baby, Adiyta(name changed), was brought to Sarvodaya Hospital, Faridabad, his parents were exhausted and anxious. For months, their child had been crying excessively every time he passed stool. He strained so hard that his face turned red, and bouts of constipation kept coming back. They had visited multiple hospitals in Delhi, where he was repeatedly treated for gas, colic, or general stomach issues. But nothing improved.

It wasn’t until they met our paediatric surgeon, Dr Shweta K. Sharma, at Sarvodaya Hospital, that the real cause finally came to light.

During examination, our specialist noticed something that had gone unseen since birth —
 a pinpoint anal opening with a tiny passage near the skin. This subtle clue confirmed the diagnosis:

This is a congenital condition present since birth, but often missed without a proper perineal inspection of the newborn. In many babies, the fistula allows air and small amounts of meconium to pass through, making the condition seem “normal.” However, as the child grows, symptoms worsen, just like in this case.

The surgery was planned immediately, and post-surgery, the baby was shifted tothe  PICU for postoperative care. Within a few days, the baby recovered well and was discharged.

Understanding Anorectal Malformation

Anorectal Malformation is a birth defect where the baby’s rectum and anus do not develop normally. The anal opening may be narrow, misplaced, or absent, and stool passes through an abnormal opening (fistula).

• Low ARM (often subtle and missed)
• Intermediate ARM
  
• High ARM (more complex, requires staged surgeries)

Symptoms of Anorectal Malformation

Anorectal malformation can be identified early if newborns are examined carefully for the following symptoms:

• Extremely narrow or abnormal anal opening
• Baby straining or crying excessively while passing stool
• Constipation from the early months
• Redness or swelling around the perineal area
• Stool passing from an unusual opening (fistula)
• Recurrent abdominal distension or enterocolitis

Causes of Anorectal Malformation

ARM is a congenital condition, meaning it develops before birth. Though the exact cause is unknown, some of the factors may include:

• Abnormal development of the hindgut in early pregnancy
• Genetic or chromosomal factors in some cases
• Maternal illnesses or environmental influences (rarely)

Diagnoses of Anorectal Malformation

The most important step is inspection of the perineal region immediately after birth.

For any suspected case, the work-up includes:

• Ultrasound (KUB) – to rule out kidney abnormalities
• 2D Echo – to rule out heart defects
• X-ray / MRI (in selected higher ARM cases)

This is crucial because:

• Nearly 30% of ARM babies may have kidney problems
  
• Around 20% may have heart defects
  

Why Timely Treatment Matters?

Early diagnosis prevents:

• Chronic constipation
• Severe pain and straining
• Repeated episodes of enterocolitis
• Rectal prolapse
• Growth issues
• Social and emotional impact as the child grows

Delayed diagnosis leads to months of pain that could have been avoided. A simple inspection at birth can change everything.

Role of a Paediatric Surgeon

A paediatric surgeon is specially trained to diagnose and treat congenital conditions in babies. Their expertise ensures:

• Early detection through antenatal scans and at birth
• Accurate diagnosis
• Choosing the right surgical technique
• Safest possible recovery for the child

At Sarvodaya Hospital, Faridabad, our paediatric surgery department is equipped with advanced technology, child-friendly infrastructure, and dedicated neonatal care, making us one of the leading centres for ARM treatment.