Management in the Newborn Period

Abstract

Figure 19.1 shows the decision-making algorithm for the initial management of male patients with anorectal malformations. When one is called to see a newborn male with an anorectal malformation, a thorough perineal inspection must be performed. This usually gives the most important clues about the type of malformation that the patient has. It is important not to make a decision about colostomy or primary operation before 24 h of life because significant intraluminal pressure is required for the meconium to be forced through a fistula orifice, which is the most reliable sign of the location of the fistula. If meconium is seen on the perineum, it is evidence of a perineal fistula. If there is meconium in the urine, a rectourinary fistula is present.