By Ny M/L/2day

77.84.94
Chief Complain : absence of anus
It has been suffered by the patient since born and
followed by abdomen getting bigger. History of vomitus
(+). History of stool came out from urinary track (-).
Micturition was normal.
He was delivered spontaneusly by midwife. History of
antenatal care with midwife (+). Birth Weight : 3200 gr,
Birth Length : 45 cm. He was the fourth child. History
of consumption of unprescribed drugs and other
traditional herbs was denied. History of congenital
defect in the family was denied.
Patient was treated from district hospital and then
referred to H. Adam Malik Hospital
Status Present:
• Awareness : Alert
• HR : 138 x / min
• RR : 50 x / min
• Temperature : 36.5 ° C
• BW : 3.200 gram
General Examination
• Head : no abnormality was found
• Neck : no abnormality was found
• Chest : no abnormality was found
• Abdomen : in localized state
• Genitalia : Male, in localized stase
• Anal : in localized state
Localized State
Abdomen :
I : Asymmetrical, distension (+), visible
bowel countur and
movement (+)
P: smooth (+)
P; tymphani, liver dulness(+)
A: peristaltik (+)
Localized State:
Anogenitalia: Male.
Female, absense of anus, fistula (-),
anal dimple (-), flat bottom (-),
bucket handle (-), midline raphe (-)
Laboratory Finding
• Hb/Ht/L/ Plt : 15.6/45/4.260/220
• Ur / Cr : 48/1.17
• Na / K / Cl : 143/4.0/105
• Random Glusoce Level : 75
Working diagnosis :
Anorectal Malformation - High Type Without Fistula
Management at the ER:
- Nill per mouth
- O2 nasal canul 2L/i
- Installation of OGT came out with greenish liquid, production 15 cc
- Instalation of urine catheter  came out clear yellow urin, production
10cc
- IVFD D5%: NS 0,225%  100cc/kg/day = 32.000cc = 38 micro drip/i
- Inj. Antibiotics  Inj. Cefotaxime 125 mg/12 hour.
- Plan: sigmoidostomy
 IN OPERATING THEATRE
• Pasient in supine position with GA-ETT, aseptic and antiseptic procedure
was performed.
• Transverse insicion on contra Mc Burney, cutis, subcutis, fascia, muscle,
peritoneum opened, came out peritoneal fluid serous ±5 cc
• Identification of sigmoid. Dilatation of sigmoid (+). Sigmoid was preserved
to outside and than performed temporary fixation with nelathon catheter.
• Proximal segment placed in lateral side and distal segment in medial side
then spurred in both side and fixated in 8 different directions.
• The proximal and distal side was separated, came out air and bowel
content, bleeding control performed.
• Stoma was closed with stoma bag.
• Operation was finished