Patterns of Associated Cardiac and Renal anomalies in Anorectal Malformation/ARM/ Patients seen at Black Line Hospital, Addis Ababa Ethiopia, November 2024 - October 2025.
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Date
2025-10-12
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Addia Ababa University
Abstract
Background:
Anorectal malformations (ARM) encompass a broad spectrum of congenital anomalies affecting the distal gastrointestinal tracts like anus and rectum as well as urinary tract, and genital tract in both boys and girls. These anomalies range from minor, easily managed cases with excellent functional outcomes to complex cases that are challenging to treat, often associated with other anomalies, and have poor functional prognoses. Approximately 50% of ARM cases present with additional defects or are part of a syndrome.
Methods:
This study was employed as an institution-based prospective cohort design. It involves direct physical examination and by reviewing medical records of cases seen or managed at Black Lion Specialized Hospital between November 2024 and October 2025. The source population was included all children admitted during this period. The study population consist of children diagnosed with ARM.
Result
A total of 59 children diagnosed with anorectal malformation (ARM) were admitted to Black Lion Specialized Hospital during the study period. Of these, 35 (59.3%) were male and 24 (40.7%) were female. The age at presentation varied: 21 children (35.6%) presented within the first 24 hours of life, while the oldest patient was a 10-year-old boy with ARM and rectoperineal fistula. Regarding the types of ARM, the most common in males were rectoperineal fistula (n=12, 34.3%) and ARM without fistula (n=11, 31.4%). In females, rectovaginal fistula was the most frequent (n=13, 54.2%), followed by persistent cloaca (n=5, 20.8%). Associated congenital anomalies were common. Cardiac anomalies were present in 29 patients (49.2%), with atrial septal defect (ASD) and patent ductus arteriosus (PDA) being the most common structural heart defects. Renal anomalies were detected in 12 patients (20.3%), predominantly hydronephrosis and renal ectopia.
Conclusion and recommendation:
A substantial proportion of children with anorectal malformation (ARM) presented to the hospital beyond 72 hours of life, underscoring the persistent need for enhanced awareness, clear communication, training, and logistical support to primary healthcare facilities and community health workers to promote early detection, prompt referral, and timely definitive management. Additionally, this study revealed that a significant number of patients, particularly males, had ARM without an overt fistula to the urinary tract (no visible fistulous communication). Consequently, a distal colostogram should be routinely performed in all cases as a fundamental diagnostic tool to precisely define the distal rectal anatomy, confirm the level of rectal atresia, identify possible occult fistulas, and guide the optimal surgical approach during definitive corrective surgery. Also MRI can be used in selected cases to see the exact location of the rectum, identify fistulas, visualize pelvic muscles and sacral bone structures, and find associated anomalies guiding precise surgical repair for better functional outcomes.
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Keywords
words: Anorectal malformation, Cardiac anomalies, renal anomalies.