IMPERFORATE ANUS  If the rectum ends close to the perineum
(below or at the level of the levator ani muscle)
 stricture of the anus
IMPERFORATE
NORMAL BOWEL FUNCTION
ANUS
FOR ANUS
In week 7 of intrauterine life
No motion
the upper bowel elongates
toward each
to pouch combine with a
other occurs/
pouch invaginating from the
the membrane
perineum two sections of
between the two
bowel meet  membranes
surfaces does not
between them are absorbed
dissolve
 the bowel is patent to the
outside.
 relatively minor  requires surgical
incision of the persistent membrane
 much more severe  involving sections of
the bowel that are many inches apart with
no anus
 There may be an accompanying fistula to
the bladder in boys and to the vagina in
girls, further complicating a surgical
repair.
 1 in 5000 live births, more commonly in
boys than in girls
 may occur as an additional complication of
spinal cord disorders
 both the external anal canal and
the spinal cord arise from the same
germ tissue layer
ASSESSMENT
prenatal sonogram -- no anus is present
membrane filled with black meconium
“wink” reflex (touching the skin near the
rectum should make it contract) is not
present
inability to insert a rubber catheter into
the rectum
abdominal distention
radiograph or sonogram
infants failed to pass stools after the first
24 hours
Collecting a urine specimen on infants
THERAPEUTIC MANAGEMENT
>repair involves simple anastomosis of
separated bowel segments
and the anal sphincter is formed
> repair becomes complicated if:
 the end of the rectum is at a distance
from the perineum (above the levator ani
muscle) or the anal sphincter exists only
in an underdeveloped form
 a fistula to the bladder or vagina is
present
> temporary colostomy for extensive repair
anticipating final repair at 6 to 12 months.
>For a successful repair, it is unnecessary for an
internal rectal sphincter to be present as long as
the subrectal muscle is judged to be intact.
NURSING DIAGNOSIS
1. Imbalanced nutrition, less than body
requirements, related to bowel obstruction
and inability for oral intake
Preoperative Care
 keep the infant NPO to avoid further
bowel distention
 nasogastric tube attached to low
intermittent suction for decompression
 to relieve vomiting and prevent
pressure on other abdominal organs or
the diaphragm from the distended
intestine
 Intravenous therapy or total
parenteral nutrition
Postoperative Care
 nasogastric tube still in place
 When bowel sounds are present and
the nasogastric tube is removed, small
oral feedings of glucose water,
formula, or breast milk can be begun
 Some are not permitted high-residue
foods to lessen the bulk of stools
2. Impaired tissue integrity at rectum related
to surgical incision
 Take axillary or tympanic
temperatures rather than rectal
temperatures to avoid loosening a
suturea
 stool softener daily
 Clean the suture line well after bowel
movements by irrigating it with normal
saline
 side-lying position
 rectal dilatation done once or twice a
day for a few months after surgery to
ensure proper patency of the rectal
sphincter
3. Risk for impaired parenting related to
difficulty in bonding with infant ill from
the birth
 parents need a great deal of
support following the diagnosis