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General Surgery


Answer 1
  1. Continued observation for 24 hours. The patient should be observed for delayed passage of meconium, as this can be normal up to 48 hours of life. If delayed beyond this period, meconium ileus, meconium plug, imperforate anus, or Hirschsprung’s disease should be considered. Evaluation of imperforate anus should include inspection for drainage of meconium through a fistula to the perineum or the urinary tract because this significantly alters treatment.1 Specifically, fistulae occur with low termination of the colon/rectum, which can be managed definitively with anorectoplasty. Absence of a fistula significantly increases the likelihood of a "high defect" imperforate anus, which can be managed with colostomy and subsequent contrast imaging of the distal colon/rectum, followed by definitive repair at a few months of age. Some surgeons obtain a cross-table lateral abdominal radiograph (not MRI) to determine where the terminal colon/rectum lies in relation to the perineum, but this approach is unnecessary and is not widely practiced. Ultrasonography and radiography are required to rule out VACTERL association, but there is no need for MRI. Intubation and mechanical ventilation are not indicated in this case.

    REFERENCE
    1. Peña A. Anorectal malformations. Semin Pediatr Surg 1995;4:35-47.

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