Anorectal malformation: Baby born without anus, bent penis and tongue-tie treated successfully in Mumbai

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Mr and Mrs Salian from Mira Road welcomed their first child into the world, however, their happiness faded when they learnt that the newborn had a congenital condition called anorectal malformation (ARM). It refers to the absence of an anal opening in the infant's body. The baby had other problems like Hypospadias which implies that the penis was bent and the opening of the urinary hole was not at the place.

Despite these challenges, the baby is now successfully reaching developmental milestones appropriate for his age with the help of Mumbai-based doctors. The infant underwent a series of five surgeries such as colostomy, anal reconstruction and colostomy closure to address issues of ARM, hypospadias and tongue tie.

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The baby was immediately admitted to the Neonatal Intensive Care Unit (NICU) at Wockhardt Hospitals, Mira Road, and initiated on parenteral nutrition since breastfeeding was not feasible. A team consisting of Dr Bhavesh Doshi, consultant pediatric surgeon, and Dr Nitu Mundhra, neonatologist successfully treated the one-year-old.

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Dr Nitu Mundhra, Consultant Neonatologist and Lactation expert, Wockhardt Hospital, Mira Road said, "ARM (anorectal malformation) is rare, and often comes as a shock to parents as it may not be diagnosed in the antenatal USG scans. It's a rare disease and one in lakh children are born with this defect. In the delivery room, all the babies are examined from head to toe to look for any abnormalities, especially when they have one abnormality."

Dr Bhavesh Doshi and Dr Nitu Mundhra

Upon finding that this baby had anal malformation, the doctors immediately looked for other abnormalities. They found out that he also had a bent-over penis along with an abnormal position for urinary meatus (Hypospadias) and a tongue tie - a condition where the tongue is attached to the floor of the mouth, it is not possible to protrude the tongue which may lead to breastfeeding problem and speech difficulty. After appropriate counseling of the parents, the baby underwent multiple surgeries.

The complete treatment of anorectal malformation was done in 3 surgical steps. At birth, a colostomy was done. In this situation, the doctors have to make a temporary opening (making a bypass passage for stool, so that the baby can be started on feed). At 2 months of age, a 4-hour-long surgery called posterior sagittal Ano Rectoplasty (PSARP) was performed where the new anus was created at the normal position. 2 months after the second surgery, the child underwent the final surgery for ARM, colostomy closure. During the surgery, the opening which was created in the abdominal wall is closed and the child now passes motions from the normal opening, informs Dr Bhavesh Doshi, pediatric surgeon, at Wockhardt Hospitals Mira Road said.

Doshi further added, "Finally, at one year of age, the child again had to undergo major surgery for correcting the bent-over penis and get the urinary opening to the normal position. After the 3-hour-long surgery, the child passed urine from the normal position at the tip of the penis."

Now the child is one year old and able to achieve all milestones as per his counterparts owing to 5 surgeries that he underwent by 1 year of age.

"Not treating him at the right time could have failed him to thrive and survive," said Dr Nitu Mundhra.

"We are thankful to the Doctors for saving our baby and giving us a new way of life. My baby is doing well now and is at par with the other kids of the same age" concluded the couple Mr. and Mrs. Salian.

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