• Alessandro Calisti, Faisal Abdelgalil Nugud, Kibreab Belay, Agnes Mlawa, and Pierluigi Lelli Chiesa.
• Pediatric Surgery - San Camillo-Forlanini Hospital - Rome - Italy.
• Afr Health Sci. 2021 Sep 1; 21 (3): 1340-1345.

IntroductionIn sub-Saharan Africa, Anorectal malformations (ARM) are the most frequent cause of neonatal obstruction. Referral to a Pediatric Surgeon is frequently delayed. The first treatment is often delivered at not specialist level and mismanagement may result.AimTo study ARM patients referred beyond neonatal period and managed at a non-specialist level.Materials And MethodsOne hundred and thirty patients were included (M/F ratio 63/67) among 144 admitted to three Eastern African Hospitals with Pediatric Surgical facilities. Demographics, type of anomaly, delay on referral, previous management, most commonly observed errors are reported.ResultsThe Mean age at referral was 23 months (range five weeks - 23 years). Colostomy was the most frequent surgery (92 cases). Stomas often did not follow the recommended criteria. Ten per cent were not on the sigmoid, and 35% were not divided. "Loop" or "double-barrel" colostomies did not exclude the distal loop. Inverted (10,5%), prolapsed stomas (7,5%), short distal loop (16%) were observed. Twenty-four cases (26%) needed redo. Primary perineal exploration in eight patients resulted in incontinence.ConclusionsInvestments on training practitioners, acting at District/Rural level, and closer links with tertiary centres are recommended to avoid ARM mismanagement and delayed referral to a Specialist.© 2021 Calisti A et al.

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