Delay in diagnosis of congenital anal stenosis
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Case report
A 1-month-old baby presented as an emergency with a 1 week history of progressive abdominal distension and pain (crying) but no vomiting. He breast fed normally but later had decreased stool frequency. He had a normal vaginal delivery at term by a 39-yr-old mother and passed normal meconium and later soft stools. He was the second sibling, the first was a normal 3-yr-old male and there was no family history of congenital anorectal or other malformations. On examination, there was a crying baby with a grossly distended abdomen. The baby was dehydrated, small for age and weighed 3 kg. The vital signs were normal. There was visible peristalsis and a tympanic abdomen with ‘tinkling’ obstructive bowel sounds. Inspection of the perineum revealed a pin-point anus showing excoriation due to passage of ‘toothpaste stools,’ and with lack of suppleness of the canal on palpation. There was no fistulous connection to skin on the penile shaft or median raphe of the scrotum. The pin hole anus could just accept a rectal thermometer with some resistance. The rest of the physical examination was normal with no other obvious congenital anomaly. A plain abdominal radiograph with oral contrast showed grossly distended colon with faeces but intestinal gas below the level of coccyx-pubis line confirming a low type anomaly.....

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