Screening practices and associated anomalies in infants with anorectal malformations: Results from the Midwest Pediatric Surgery Consortium

J Pediatr Surg. 2018 Jun;53(6):1163-1167. doi: 10.1016/j.jpedsurg.2018.02.079. Epub 2018 Mar 7.


Background: This study evaluates screening practices and the incidence of associated anomalies in infants with anorectal malformations (ARM).

Methods: We performed a multi-institutional retrospective cohort study of children born between 2007 and 2011 who underwent surgery for ARM at 10 children's hospitals. ARM type was classified based on the location of the distal rectum, and all screening studies were reviewed.

Results: Among 506 patients, the most common ARM subtypes were perineal fistula (40.7%), no fistula (11.5%), and vestibular fistula (10.1%). At least 1 screening test was performed in 96.6% of patients, and 11.3% of patients underwent all. The proportion of patients with ≥1 abnormal finding on any screening test varied by type of ARM (p<0.001). Screening rates varied from 15.2% for limb anomalies to 89.7% for renal anomalies. The most commonly identified anomalies by screening category were: spinal: tethered cord (20.6%); vertebral: sacral dysplasia/hemisacrum (17.8%); cardiac: patent foramen ovale (58.0%); renal: hydronephrosis (22.7%); limb: absent radius (7.9%).

Conclusion: Screening practices and the incidence of associated anomalies varied by type of ARM. The rate of identifying at least one associated anomaly was high across all ARM subtypes. Screening for associated anomalies should be considered standard of care for all ARM patients.

Type of study: Multi-institutional retrospective cohort study.

Level of evidence: III.

Keywords: Anorectal malformation; Associated anomalies; Congenital malformations; Screening rates; VACTERL.

MeSH terms

  • Abnormalities, Multiple / diagnosis*
  • Abnormalities, Multiple / epidemiology
  • Anorectal Malformations / diagnosis*
  • Anorectal Malformations / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Midwestern United States / epidemiology
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retrospective Studies