Known as an anorectal malformation, imperforate anus is a birth defect in which the anus and the rectum are not properly developed and the patient is born without an anal opening, or the anal opening is in the wrong place. Anorectal malformations occur in 1 out of 5,000 infants born.
Normally, the rectum and anus are formed during the 5th – 8th weeks of gestation. In the case of imperforate anus, the anal membrane fails to rupture and form the anus. There may be some genetic links to the development of imperforate anus. Studies have shown a link in patients with this condition and Down’s Syndrome and other congenital abnormalities. This condition is normally diagnosed within the first 24 hours of life and surgical intervention is usually necessary.
Patient will have normal fluid balance; patient will be free from infection; patient will have a normal elimination pattern.
Perform complete physical assessment
This condition is usually diagnosed within the first 24 hours of life. Note if the patient has anal opening and if it appears to be located in the anatomically correct location.
Observe for passage of meconium stools
Patients with imperforate anus are either unable to pass stool (meconium) at all, or it is passed from an inappropriate location. For female infants, carefully note if the meconium is passed from anus, vagina or urethra. For male patients, the anal opening may be located below the penis or the scrotum.
Monitor vital signs
Patients will often have other congenital malformations. Monitor heart rate and rhythm, respiratory effort and rate and temperature. Axillary temperature may be more appropriate instead of rectal.
Prepare patient for diagnostic tests and surgery
Patient will likely undergo several tests including imaging and labs prior to the determination for surgery. Ultimately, the patient may require a colostomy placed.
Monitor skin integrity and provide wound care following surgery
The passage of stool from incorrect locations can lead to rapid skin breakdown. Following surgery, assess incision site and provide wound care per facility protocol. Observe for signs of infection.
Provide colostomy care if appropriate
A colostomy may be required. Provide colostomy care per facility protocol and as needed. Educate parents to care for patient with colostomy. Assess the stoma for bleeding or signs of infection.
Provide education for parents
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