Copyright ©The Author(s) 2016.
World J Gastroenterol. Jul 14, 2016; 22(26): 5867-5878
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5867
Table 3 Common anorectal disorders presenting with delay or failure to pass meconium in the neonates
DiagnosisRateCommon physical findingsSuggested investigation: expected findingsInitial management
Meconium plug syndrome1/500-1000Abdominal distension, normal anus and anal sphincter complexContrast enema radiologic examination: meconium plug in colonRectal stimulation with finger or saline enema
Hirschsprung’s disease1/4000Abdominal distension, tight anal sphincter, empty rectum, sudden evacuation of stool on digital rectal examination if “transitional zone” is reachedContrast enema radiologic examination without colonic preparation: transitional zone separating aganglionic segment and dilated proximal colonIntravenous hydration, gastric decompression, rectal washout with warm saline, and consider colostomy in high-grade obstruction and intravenous board-spectrum antibiotics in those with suspected diagnosis of Hirschprung-associated enterocolitis
Imperforate anus (IA)1/5000Absence or stenosis of anus, perineal fistula (low IA), meconium in urine (rectourinary fistula: low or high IA), flat or not well formed median raphe (high IA), cloaca (high IA), VACTERL anomalies1Inverted lateral radiography (invertography) or transperineal ultrasonography: differentiation between low IA and high IAAnal or fistula dilatation for temporary relief of obstruction and plan for elective posterior sagittal anorectoplasty (low IA), loop sigmoid colostomy (high IA or some low IA)
- Low IA = distal rectal pouch lining below or at the puborectalis muscle
- High IA = distal rectal pouch lining above the puborectalis muscle