Anal atresia: A report on 10 cases

Introduction: Anal atresia is a congenital anorectal malformation characterized by the complete absence of an opening connecting the rectum to the skin of the perineum. The diagnosis should be made at birth, during the newborn’s examination in the delivery room. If this does not occur, the newborn will present with symptoms of intestinal obstruction, including abdominal distension and bilious vomiting.
Materials and Methods: Our retrospective study includes 10 cases of anal atresia treated in 2025 at the pediatric neonatology unit of the Rabat Children’s Hospital.
Results: The newborns were predominantly male; 9 out of 10 pregnancies were well managed and carried to term, with one preterm birth at 36–37 weeks’ gestation; 9 out of 10 pregnancies resulted in vaginal deliveries, with birth weights ranging from 2000 g to 5000 g; and Apgar scores were normal in half of the cases. The medical history revealed no history of urogenital infection during the first trimester in the mothers, nor any history of exposure to teratogenic medications or tobacco or alcohol use during that period. Furthermore, there is no history of congenital malformations in the family. However, a case of third-degree consanguinity was reported in a single mother with a history of gestational diabetes who was on a diet.
Our patients were admitted between 10 hours and 5 days of life; one-third were admitted due to low neonatal obstruction associated with high anorectal malformation. There was one case of meconium passage through the vagina and four postoperative cases (including two cases with respiratory distress), as well as one preoperative case requiring correction of hyponatremia.
Three out of 10 cases presented with abdominal distension, one case with an ectopic testicle, one case of ambiguous genitalia, and one case with an absent urethral meatus; one newborn presented with trisomic facial features. The malformation screening identified cardiovascular anomalies in half of the patients. Transfontanellar ultrasound was normal in 9 out of 10 cases, and renal ultrasound showed no abnormalities. They received broad-spectrum antibiotic therapy, intravenous fluid replacement, and parenteral analgesia.
Conclusion: This condition is routinely diagnosed in the delivery room. Its severity lies in the presence of associated anomalies. Medical management is part of a multidisciplinary approach that includes medical, surgical, radiological, and genetic care.