A newborn baby presents with absent anal orifice and meconuria. What is the most appropriate management:: (A) Transverse colostomy, (B) Conservative management, (C) Posterior saggital anorectoplasty, (D) Perineal V-Y plasty
Answer is A. The presence of meconium in urine reflects some form of communication between the urinary tract and rectum, and suggests a high type of anorectal malformation. Such patients require a diveing colostomy. The colostomy decompresses the bowel and provides protection during the healing of subsequent repair. Posterior Saggital Anorectoplasty (PSARP) is performed after 4-8 weeks. The presence of meconium in urine and a flat bottom are considered indications of a protective colostomy.