Juvenile/Children`s Health centre ltd, Ghana
Title: The need to do rectal examination on newborns with recurrent gaseous distension of the abdomen
Congenital Anal Stenosis occurs as a result of development aberration of the Gastrointestinal System, during the embryonal developmental period. The occurrence being one in every 5000 live births (1:5000) (This is the incidence for all anorectal malformations not anal stenosis alone). It may be necessary to consider routine digital rectal examination of the newborn in cases of recurrent meteorism (gaseous distention of the abdomen) in the neonatal period to avert more serious complications in case, the diagnosis is missed in this critical period. In low income countries, where paediatric surgeons are scarce, it may be necessary for the few paediatricians available to employ simple methods for diagnosis as well as therapy for congenital anal stenosis. Not all congenital anal stenosis can be treated by dilatation alone. In some cases, the finger may not be able to enter till smaller dilators are used. In others a surgical procedure such as posterior sagittal anoplasty may be required. This is done through the cautious insertion of the well-lubricated gloved fifth finger in the anus. This method will work for some types of anal stenosis but not for all types. This would normally cause the anal muscles to relax without pain to the newborn. In case the newborn should start crying as the examiner’s finger reaches the tight anal ring, this is at the same time a signal for the parents and the examiner that we are dealing here with the diagnosis congenital anal stenosis; the post digital dilatation process may result in gushing out of the residual watery stool and flatus after removal of the finger and this further more confirms the diagnosis, congenital anal stenosis to the parents as well. To avert late serious complications of the gastrointestinal system as a result of missed diagnosis in the neonatal period, it is recommended that digital examination be done on any newborn with recurrent gaseous distention of the abdomen despite medications. In conclusion, as it is mandatory to examine every casualty with abdominal problems rectally likewise it can be said that newborns with abdominal challenges should also be examined in that manner all the time, This may prevent complications in those with anal stenosis who respond to this treatment. It would also aid early diagnosis in those who may need referral to a surgeon for further management.