• Ariadne Tiara Hapsari Universitas Jenderal Soedirman


Anal atresia or anorectal malformation (MAR) or imperforate anus is a congenital abnormality that includes the distal anus, rectum and also the urogenital tract. Is a congenital abnormality that is often encountered in pediatric surgery cases. This condition has varying degrees of severity ranging from imperforate anal membrane to complete caudal regression. History and physical examination are very important in diagnosing anorectal malformations. Treatment of atresia ani consists of surgery to create an artificial anal opening and rectal muscle reconstruction. Surgery is performed within the first 48 hours of birth to prevent infection and other complications. The prognosis for atresia ani is generally good if treated properly. Postoperative care and long-term follow-up are important to monitor rectal function and defecation.



Abadi SA, Abadi NA, Mashrabi O, F.H. ;2008. Congenital Heart Disease in ARM.Research Journal of Biological Science.3(8);922-924.
Alamo, L., Meyrat, B.J., Meuwly, J.Y., Meuli, R.A., & Gudinchet, F., 2013. Anorectal malformations: Finding the pathway out of the labyrinth. Radiographics 33: 491–512. doi:10.1148/rg.332125046
Ali, I., Mufti, G.N., Bhat, N.A., Baba, A.A., Sheikh, K.A., Hamid, R., et al., 2018. Assessment of Predictors of Mortality in Neonatal Intestinal Obstruction. doi:10.21699/jns.v7i1.654
Arnoldi, R., MacChini, F., Gentilino, V., Farris, G., Morandi, A., Brisighelli, G., et al., 2014. Anorectal malformations with good prognosis: Variables affecting the functional outcome. J. Pediatr. Surg. 49: 1232–1236. doi:10.1016/j.jpedsurg.2014.01.051
Bǎlǎnescu, R.N., Topor, L., & Moga, A., 2013. Anomalies associated with anorectal malformations. Chir. 108: 38–42. doi:10.5958/2321-1024.2016.00036.2
Beck, J., Nour,S.,Stringer, MD.,1996. Colostomy complication in infants and children.Ann. R. Coll.Surg. Eng.; 78: 526–530.
Beudeker, N., Broadis, E., Borgstein, E., & Heij, H.A., 2019. The hidden mortality of imperforate anus. doi:10.4103/0189-6725.125417
Bhatt, S., Agrawal, P., Patel, A., & Tamboli, D., 2015. Audit of sepsis in neonatal surgeries at tertiary-care level hospital in India. Int. J. Med. Sci. Public Heal. 4: 1715. doi:10.5455/ijmsph.2015.01052015354
Cassina, M., Fascetti Leon, F., Ruol, M., Chiarenza, S.F., Scirè, G., Midrio, P., et al., 2019. Prevalence and survival of patients with anorectal malformations: A population-based study. J. Pediatr. Surg. 54: 1998–2003. doi:10.1016/j.jpedsurg.2019.03.004
Chowdhary, S.K., Chalapathi, G., Narasimhan, K.L., Samujh, R., Mahajan, J.K., Menon, P., et al., 2004. An audit of neonatal colostomy for high anorectal malformation: The developing world perspective. Pediatr. Surg. Int. 20: 111–113. doi:10.1007/s00383-003-1100-8
Clinical, Q., & Queensland, G., n.d. Maternity and Neonatal Clinical Guideline Routine newborn assessment.
Dahlan, M.S., 2013. Besar Sampel dan Cara Pengambilan Sampel, Tiga. ed. Salemba Medika, Jakarta.
Darussalam, D., 2013. Faktor Risiko yang Mempengaruhi Luaran Klinis Malformasi Anorektal pada Neonatus di RSUD Dr. Zainoel Abidin, Banda Aceh 15: 51–55.
Dewberry, L., Alaniz, V., Wilcox, D.T., de La Torre, L., Peña, A., & Bischoff, A., 2020. From Prenatal Diagnosis Through Transition to Adult Care: What Everyone Should Know About Anorectal Malformations. Curr. Treat. Options Pediatr. 6: 91–100. doi:10.1007/s40746-020-00194-4
Ekenze, S.O., Ajuzieogu, O. V., & Nwomeh, B.C., 2016. Challenges of management and outcome of neonatal surgery in Africa: a systematic review. Pediatr. Surg. Int. 32: 291–299. doi:10.1007/s00383-016-3861-x
Eltayeb, A.A., 2010. Delayed presentation of anorectal malformations : the possible associated morbidity and mortality 801–806. doi:10.1007/s00383-010-2641-2
Falcone, R.A., Levitt, M.A., Peña, A., & Bates, M., 2007. Increased heritability of certain types of anorectal malformations. J. Pediatr. Surg. 42: 124–128. doi:10.1016/j.jpedsurg.2006.09.012
Fisher, R., 2007. Mortality and morbidity associated with late diagnosis of anorectal malformations in children. Surg. 5: 327–330. doi:10.1016/S1479-666X(07)80083-7
Gangopadhyay, A.N., & Pandey, V., 2015. R eview A rticle Anorectal malformations. J. Indian Assoc. Pediatr. Surg. 20. doi:10.4103/0971-9261.145438
Gokhroo, R.K., Gupta, S., Arora, G., Bisht, D.S., Padmanabhan, D., & Soni, V., 2015. Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: An Indian study. Heart Asia 7: 29–31. doi:10.1136/heartasia-2014-010561
Govender, S., & Wiersma, R., 2016. Delayed diagnosis of anorectal malformations (ARM): causes and consequences in a resource-constrained environment. Pediatr. Surg. Int. 32: 369–375. doi:10.1007/s00383-016-3866-5
Gupta R., Gupta A.K., Shukla A.K, Chaturvedi V., Sharma P., T.R., 2019. Anorectal Malformations: Early Outcome Analysis from a High‑volume Tertiary Care Institute. doi:10.4103/mjdrdypu.mjdrdypu
Houben, C.H., Chan, K.W.E., Pang, K.Y.K., Feng, X.-N., Mou, W.C.J., Tam, Y.H., et al., 2017. Descriptive Epidemiology of Anorectal Malformations in Chinese Population. J. Neonatal Surg. 6: 74. doi:10.21699/jns.v6i4.531
Id, S.M., Godinho, M.A., Id, V.G., Edward, L., Lewis, S., & Nair, N.S., 2019. Risk factors of neonatal sepsis in India : A systematic review and meta-analysis 1–26.
Janssen, P.A., Thiessen, P., Klein, M.C., Whitfield, M.F., Ying, C., & Cullis-kuhl, S.C., 2007. Standards for the measurement of birth weight, length and head circumference at term in neonates of European, Chinese and South Asian ancestry 1.
Kemal, M., Onen, A., & Duran, H., 2006. The mechanical complications of colostomy in infants and children : analysis of 473 cases of a single center 671–676. doi:10.1007/s00383-006-1718-4
Kemenkes, 2018. InfoDATIN: Kelainan bawaan. Pus. Data dan Inf. Kemeterian Kesehat. RI 1–6.
Kim, H.L.N., Gow, K.W., Penner, J.G., Blair, G.K., Murphy, J.J., & Webber, E.M., 2000. Presentation of Low Anorectal Malformations Beyond the Neonatal Period. Pediatrics 105: e68–e68. doi:10.1542/peds.105.5.e68
Kluth, D., 2010. Embryology of anorectal malformations. Semin. Pediatr. Surg. 19: 201–208. doi:10.1053/j.sempedsurg.2010.03.005
Kluth, D., Fiegel, H.C., & Metzger, R., 2011. Embryology of the hindgut. YSPSU 20: 152–160. doi:10.1053/j.sempedsurg.2011.03.002
Kuijper, C.F., & Aronson, D.C., 2010. Anterior or posterior sagittal anorectoplasty without colostomy for low-type anorectal malformation : how to get a better outcome ? J. Pediatr. Surg. 45: 1505–1508. doi:10.1016/j.jpedsurg.2010.02.042
Kumar, A., Agarwala, S., Srinivas, M., Bajpai, M., Bhatnagar, V., Gupta, D.K., et al., 2005. Anorectal malformations and their impact on survival. Indian J. Pediatr. 72: 1039–1042. doi:10.1007/BF02724407
Lawal, T.A., 2019. Overview of Anorectal Malformations in Africa 6: 1–10. doi:10.3389/fsurg.2019.00007
Levitt, M.A., & Peña, A., 2010. Imperforate Anus and Cloacal Malformations. Ashcraft’s Pediatr. Surg. 468–490. doi:10.1016/B978-1-4160-6127-4.00036-7
Lindley, R.M., Shawis, R.N., & Roberts, J.P., 2006. Delays in the diagnosis of anorectal malformations are common and significantly increase serious early complications. Acta Paediatr. Int. J. Paediatr. 95: 364–368. doi:10.1080/08035250500437523
Mundt, E., & Bates, M.D., 2010. Genetics of Hirschsprung disease and anorectal malformations. Semin. Pediatr. Surg. 19: 107–117. doi:10.1053/j.sempedsurg.2009.11.015
Nah, S.A., Ong, C.C.P., Lakshmi, N.K., Yap, T.L., Jacobsen, A.S., & Low, Y., 2012. Anomalies associated with anorectal malformations according to the Krickenbeck anatomic classification. J. Pediatr. Surg. doi:10.1016/j.jpedsurg.2012.09.017
Nitin, P., R., K.T., Shweta, M., Piyush, K., Yadvendra, D., & Ashish, W., 2018. Diagnostic suggestion and surgical consideration for Hirschsprung’s disease associated with high anorectal malformation. Ann. Pediatr. Surg. 78–82. doi:10.1097/01.XPS.0000516305.51236.12
Ogundoyin, O.O., & Olulana, D.I., 2021. Experience with the management of anorectal malformations in Ibadan , Nigeria.
Osifo, O., Udefiagbon, E., & Osagie, T., 2014. Outcome of primary posterior sagittal anorectoplasty of high anorectal malformation in well selected neonates. Niger. J. Clin. Pract. 17: 1. doi:10.4103/1119-3077.122821
Patel, J.L., Memon, M.A., Sharma, S., & Verma, J., 2018. Assessment of post-surgical functional outcome in children with anorectal malformation 5: 1286–1290.
Peña, A., & Levitt, M.A., 2006. Imperforate Anus. Pediatr. Gastrointest. Liver Dis. 749–755. doi:10.1016/B978-0-7216-3924-6.50053-6
Pena, A., Migotto-krieger, M., & Levitt, M.A., 2006. Colostomy in anorectal malformations : a procedure with serious but preventable complications 748–756. doi:10.1016/j.jpedsurg.2005.12.021
Penington, E.C., & Hutson, J.M., 2002. The cloacal plate: The missing link in anorectal and urogenital development. BJU Int. 89: 726–732. doi:10.1046/j.1464-410X.2002.02655.x
Rintala, R.J., 2009. Congenital Anorectal Malformations : Anything New ? J.Ped.Gastroenterology and Nutrition.48:S79-S82.
Risk, F., Pascale, S., & Hamadé, A., 2014. Congenital Anomalies: Prevalence and Risk Factors. Univers. J. Public Heal. 2: 58–63.
Sheikh MA, Akhtar J, As., 2014. Complications / Problems of Colostomy in Infants.
Singh, S., Wakhlu, A., Pandey, A., Singh, A., Kureel, S.N., Rawat, J., et al., 2012. Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario. J. Indian Assoc. Pediatr. Surg. 17: 107–110. doi:10.4103/0971-9261.98123

Sinha, S., Kanojia, R., Wakhlu, A., Rawat, J.D., Kureel, S.N., & Tandon, R.K., 2008. Delayed presentation of anorectal malformations. J. Indian Assoc. Pediatr. Surg. 13: 64–68. doi:10.4103/0971-9261.43023
Sloots, C., Meeussen, C., & Wijnen, R., 2014. To Split or Not to Split : Colostomy Complications for Anorectal Malformations or Hirschsprung Disease : A Single Center Experience and a Systematic Review of the Literature.
Statovci, S., Grajçevci, S., Berisha, M., Çeku, G., Ademaj, I., & Ukeperaj, K., 2015. Late Diagnosis of Anorectal Malformations in Children 143–148.
Svenningsson, A., Gunnarsdottir, A., & Wester, T., 2018. Maternal risk factors and perinatal characteristics of anorectal malformations ☆ , ☆☆. J. Pediatr. Surg. 53: 2183–2188. doi:10.1016/j.jpedsurg.2018.04.021
Turowski, C., Dingemann, J., & Gillick, J., 2010. Delayed diagnosis of imperforate anus: An unacceptable morbidity. Pediatr. Surg. Int. 26: 1083–1086. doi:10.1007/s00383-010-2691-5
Umar Nisar, M., Iqbal, A., Javed, N., Sikander, S., Burki, S.A., & Chaudhry, M.A., 2021. Factors affecting the outcome of neonates with anorectal malformation in a developing country. J. Pediatr. Adolesc. Surg. 1: 1–4. doi:10.46831/jpas.v1i2.30
Vermes, G., László, D., Czeizel, A.E., & Ács, N., 2016. Birth outcomes of patients with isolated anorectal malformations : A population-based case-control study 41–45. doi:10.1111/cga.12130
Wang, C., Li, L., Liu, S., Chen, Z., & Diao, M., 2015. The management of anorectal malformation with congenital vestibular fistula : a single-stage modified anterior sagittal anorectoplasty 1–6. doi:10.1007/s00383-015-3749-1
Wijers, C.H.W., Rooij, I.A.L.M. Van, Marcelis, C.L.M., Brunner, H.G., Blaauw, I. De, & Roeleveld, N., 2014. Genetic and Nongenetic Etiology of Nonsyndromic Anorectal Malformations : A Systematic Review 6. doi:10.1002/bdrc.21068
Willian, H., Silva, L., Garcia, L., & De, P., 2017. Prevalence of Congrnital Anomalies and Their Associated factors in newborns in the city of Sau pauloo from 2010 To 2014.
Zamil, A.L., Hasan, H.S., Ch, M.B.B., & Health, P., 2018. Colostomy in Anorectal Malformation and Hirschsprung ’ s Disease in Infants and Children 14: 464–475. doi:10.19044/esj.2018.v14n18p464
Zwink, N., & Jenetzky, E., 2018. Maternal drug use and the risk of anorectal malformations: Systematic review and meta-analysis. Orphanet J. Rare Dis. 13: 1–23. doi:10.1186/s13023-018-0789-3
How to Cite
HAPSARI, Ariadne Tiara. DIAGNOSIS AND MANAGEMENT OF ATRESIA ANI IN NEWBORN INFANTS: LITERATURE REVIEW. Mandala Of Health, [S.l.], v. 16, n. 2, p. 156-169, aug. 2023. ISSN 2615-6954. Available at: <http://jos.unsoed.ac.id/index.php/mandala/article/view/9643>. Date accessed: 01 mar. 2024. doi: https://doi.org/10.20884/1.mandala.2023.16.2.9643.