Anorectal Malformations

Key Points Anorectal malformations (ARMs) encompass a broad range of anatomical conditions in which a normal anal opening is absent and the colon empties anteriorly via an abnormal fistulous connection to other pelvic organs or the perineum.Children should be diagnosed shortly after birth. They require workup for commonly associated anomalies, especially VACTERL (Vertebral, anorectal, cardiac, tracheal, esophageal, renal, and limb) association.Definitive treatment is surgical, with the goal to take down all abnormal fistulous connections and appropriately center the distal rectum into the sphincter complex, while maximizing functional potential and minimizing morbidity as much as possible.Some patients require a temporary diverting ostomy before surgery.After surgery, patients should be monitored for appropriate feeding, growth, and continence as they reach toilet-training age. If a child is not meeting these milestones, they should be referred for surgical evaluation.With bowel management programs, many children with ARMs may achieve continence or cleanliness and have an increased quality of life.