Pediatric Surgery - San Camillo-Forlanini Hospital - Rome - Italy.
Gezira National Centre for Pediatric Surgery - Wad Medani - Sudan.
Afr Health Sci. 2021 Sep;21(3):1340-1345. doi: 10.4314/ahs.v21i3.45.
In 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.
To study ARM patients referred beyond neonatal period and managed at a non-specialist level.
One 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.
The 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.
Investments 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.
在撒哈拉以南非洲，肛门直肠畸形（ARM）是新生儿梗阻的最常见原因。向小儿外科医生转诊常常会延迟。最初的治疗通常由非专业人员进行，可能会导致处理不当。
研究在非专科水平接受治疗的超出新生儿期的 ARM 患者。
在三家设有小儿外科设施的东非医院收治的 144 名患者中，纳入了 130 名患者（男女比例为 63/67）。报告了人口统计学、畸形类型、转诊延迟、先前的管理以及最常见的错误。
转诊时的平均年龄为 23 个月（范围为五周至 23 岁）。结肠造口术是最常见的手术（92 例）。造口往往不符合推荐的标准。10%的造口不在乙状结肠上，35%的造口没有分开。“环”或“双筒”造口术并没有排除远端的环。观察到倒置（10.5%）、脱垂造口（7.5%）和短的远端环（16%）。24 例（26%）需要再次手术。8 例患者行原发性会阴探查术导致失禁。
建议对在地区/农村一级开展工作的从业人员进行培训，并与三级中心建立更紧密的联系，以避免 ARM 处理不当和延迟向专家转诊。
