Birth defects- Boy born without anal opening needs operation
Dec 14, 2009
TWELVE-YEAR old Joseph Wasswa was born without an anus and before his parents, Margaret Nabisunsa and Joseph Mubiru, could complete the required hospital visits for the corrective operations, they died.
TWELVE-YEAR old Joseph Wasswa was born without an anus and before his parents, Margaret Nabisunsa and Joseph Mubiru, could complete the required hospital visits for the corrective operations, they died.
His paternal aunt and now caretaker, Harriet Naggita, explains that Wasswa’s mother found that one of her twins did not have an anus a day after he was born.
Fortunately, she had delivered from Mulago Hospital, where it was possible to operate the baby. An outlet was created on his tummy to allow stool passage as they awaited an operation for a proper anus when he turned one year old.
Naggita explains that Wasswa’s parents were asked to take the baby back for continuous review but it was not possible since they died before this problem was fully resolved.
Wasswa cannot control the stool outlet. As a result, he soils his clothes and does not go to school because he has been sent away from all the schools he has attempted to go to.
“They (teachers) were always angry with me. They would say that I was big child who defecated in class without shame when the fact is I do not get the feeling to use a toilet,†Wasswa explains. “I would explain to them but they would not listen.â€
Wasswa’s father (Mubiru) was an employee of National Water and Sewerage Corporation, Entebbe branch before his death.
As a result, the manager of the branch then connected a water tap for the orphaned family for income generation.
Unfortunately, the tap has been disconnected because the family failed to pay the monthly bills.
Wasswa, who was manning the tap is now redundant. He is now a big boy and feels embarrassed by his condition
“I also want to go back to school,†he says.
“I pray to God that someone can come up to assist me overcome this problem, I feel so bad when people hold their noses because of my stench.â€
About anorectal malformation
According to a paediatric surgeon at Mulago Hospital, Dr. John Sekabira, Wasswa was born with a condition known as anorectal malformation or imperforate anus.
It happens more in boys than girls. Babies with the condition have a malformation in the rectum. Internationally, about one baby in every 5000 live births has the defect.
Dr Sekabira says cases like Wasswa’s are becoming common at Mulago Hospital, with two to four babies seen in a month. (Mulago delivers 30,000 babies a year, which translates into an average of 2,500 babies a month).
He says the defect happens during early pregnancy when a foetus is developing. In babies born with the condition, the anus and rectum found at the lower end of the intestines do not develop properly.
He explains that the causes have not yet been found although some viral infections or drugs if taken between the first and the eighth weeks of a mother’s pregnancy could also contribute to the problem.
“These (infections and drugs) can affect the development of either the heart or urinary system and once the baby is born with the combined defects, it will be difficult to heal,†Dr. Sekabira says.
He advises early operation in such cases but adds that it is difficult in cases, where the defect causes a disconnection between the intestine and the anus.
Early detection key
Dr. Sekabira says if the stool or meconium remains in the baby’s intestine for long after birth, it will cause the baby to vomit or swelling of the abdomen.
He observes that many parents delay to take the children to hospital only to arrive when it is too late. This makes the operations difficult.
He explains that there are two most common types. In one, the rectum does not develop to reach the anus in the pelvic floor. In the second one, the rectum develops but has no anal opening.
In some cases, boys born without an anal opening will have fistula, which causes passing of stool through any other passage like the urinary system.
Girls born without an anal opening may pass stool through an opening near the vagina. Other babies can be born without separate systems for urine or stool.
Dr. Sekabira says they end up passing both urine and stool through a common opening in the perineum. A temporary outlet is made on the tummy, which is later closed after a year when the operation of the proper anus has occurred.
“Correcting this defect is not easy but as medics, we try to make the best out of the worst situation,†he notes. A baby with anorectal malformation will usually have other abnormalities involving other systems.
A bit of hope
Normal passage of stool depends on nerves, which connect together within the rectum and the sphincters, which control the mechanism of passing stool.
If the sphincters are not well innervated, that is not well supplied with nerves, the child will not have a good continence of stool. A child with a back abnormality will also have abnormal innervation of the sphincters.
In this case, he notes that even after operation, these children will still have problems and will not be able to pass stool normally. Most will never have good continence of the stool.
A baby with an imperforated anus however, can be helped to have satisfactory continence and live a normal life if thecase is handled early.
Those referred late are a problem because some surgical procedures supposed to be established early enough become difficult later. If operated late, that connection will not be there and they will not pass out stool normally.
In such cases, there is need to train them to be able to pass stool normally. Parents or caretakers are also helped to train the child.
After operation, the newly created anal opening needs continuous dilating. The child needs continuous and regular reviews and cautions that without good caretakers, the children may never learn to pass stool well.