imperforate anus
DESCRIPTION
Imperforate Anus. Maria Ellaine Grace K. Uy, MD. Pertinent Data: Imperforate Anus. PBR Delivered via Scheduled Repeat Cesarean Section 33 year old G2P2 (2002) AOG: 38 1/7 weeks MT: 38 AGA Apgar Score: 9,9. Anthropometrics: BW= 3350 grams BL= 52 cm HC= 34 1/2 cm CC= 34 cm AC= 29 cm. - PowerPoint PPT PresentationTRANSCRIPT
Imperforate AnusMaria Ellaine Grace K. Uy, MD
Pertinent Data: Imperforate Anus
• PBR• Delivered via Scheduled Repeat Cesarean
Section • 33 year old G2P2 (2002)• AOG: 38 1/7 weeks• MT: 38 AGA• Apgar Score: 9,9
•Anthropometrics:• BW= 3350 grams• BL= 52 cm• HC= 34 1/2 cm• CC= 34 cm• AC= 29 cm
Pertinent History: Imperforate Anus
• Maternal History: 3rd Trimester, Cough and Colds, no medications given
• Past Medical History: Scoliosis s/p Spine surgery (1993)
• Family History: Diabetes, Hypertension
• OB History: • G1- 2009- PCS for Arrest of descent- LFT-
Male- TMC- No FMC• G2: Present Pregnancy
• Personal Social: Post-graduate, Works as a market researcher, no vices
Physical Examination: Imperforate Anus
• Had good cry and activity• Clear amniotic fluid• Flat and open fontanelles• Good air entry, no retractions• Regular cardiac rhythm, HR at 150 bpm• Soft Abdomen• Grossly male genitalia• Imperforate Anus• Full pulses
Diagnosis: Imperforate Anus
• Term Baby Boy• t/c Imperforate Anus
PLANS:
• Transfer to Level III care
• Maintain on NPO• Referral to Surgery
Course in the NICU: Imperforate Anus
Subjective
ObjectiveAssessme
ntPlan
-5th HOL-On NPO-No
vomiting-Active
-T: 36.7, HR 143, RR: 44
-Good air entry, no retractions
-Good cardiac tone
-Soft abdomen
-(+) Imperforate anus
-Term Baby Boy
-t/c Imperforate Anus
-Insert OGT-For
Babygram-Observe
for any fecalith material with UO
-IVF-HGT
monitoring
Course in the NICU: Imperforate Anus
Subjective
ObjectiveAssessme
ntPlan
-7th HOL-On NPO-No
vomiting-Active-(+) UO: no
Fecalith matter noted
-T: 36.9, HR 147, RR: 42
-Good air entry, no retractions
-Good cardiac tone
-Soft abdomen
-(+) Imperforate anus
-Babygram: Normal
-Term Baby Boy
-t/c Imperforate Anus
-IVF
Course in the NICU: Imperforate Anus
Subjective
ObjectiveAssessme
ntPlan
-20th HOL-On NPO-No
vomiting-Active-(+) UO
-T: 36.7, HR 151, RR: 43
-Good air entry, no retractions
-Good cardiac tone
-Soft abdomen, slightly dilated
-(+) Imperforate anus
-Term Baby Boy
-t/c Imperforate Anus
-For cross table lateral abdominal X-ray in prone position
-For anoplastly
-Start Ampicillin and Gentamycin
Course in the NICU: Imperforate Anus
Subjective
ObjectiveAssessme
ntPlan
-26th HOL-No
vomiting-(+) UO-Evacuation
of meconium intra-op
-Stable vital signs
-Good air entry, no retractions
-Good cardiac tone
-Soft abdomen
-(+) Anal pack
-Term Baby Boy
-Imperforate Anus
-s/p Anoplasty
-Feedings resumed
Course in the NICU: Imperforate Anus
Subjective
ObjectiveAssessme
ntPlan
-3rd DOL-Tolerates
20 ml every 2 hours with breastfeeding
-No vomiting
-(+) UO-(+)
meconium
-Good air entry, no retractions
-Good cardiac tone
-Soft abdomen
-Full pulses
-Term Baby Boy
-Imperforate Anus
-s/p Anoplasty
-For rooming in (Discharged at the 5th DOL)
Imperforate Anus
-Absence of an anal opening
-Occurs in 1 in 5000 births
- May have other associated problems: VACTERL
Orphanet J Rare Dis. 2011; 6: 56.Published online 2011 August 16. doi: 10.1186/1750-1172-6-56
Cross table lateral prone Xray
If the air column is more than 1 cm
from the perineum, a colostomy is
indicated.
Anoplasty
Colostomy
A flat bottom or flat perineum, as evidenced by the lack of a midline
gluteal fold and the absence of an anal
dimple, indicates that the patient has poor muscles
in the perineum.
The presence of meconium at the
perineum, a bucket-handle malformation (ie, a
prominent skin tag located at the anal dimple, below which an instrument can be passed), and an anal
membrane (through which meconium is visible).