Résumé

Introduction : L’examen systématique du périnée chez le nouveau-né a permis la prise en charge précoce des malformations anorectales dans les pays développés. Cependant, elles demeurent une cause fréquente d’occlusion néonatale encore d’actualité dans nos pays en développement. L’objectif était d’analyser les circonstances diagnostiques des malformations anorectales dans notre pratique.
Patients et méthodes : Nous avons réalisé une étude rétrospective bi-centrique sur les dossiers des nouveau-nés porteurs de malformation anorectale, traités entre janvier 2012 et juin 2019 dans les CHU de Yopougon et de Treichville à Abidjan. Les circonstances diagnostiques étaient analysées.
Résultats : L’étude a porté sur 235 cas. Le sex-ratio était de 1,4. Les accouchements ont eu lieu dans un centre de santé dans 192 cas (81,7%) et à domicile dans 43 (18,3%). La découverte de la malformation anorectale était faite à domicile par les parents dans 166 cas (70,7%). Le délai diagnostique moyen était de 3,2 jours. Dans 129 cas (54,8%), la découverte était faite après la 48ème heure de vie. Les circonstances de découverte par les parents étaient la tentative de lavement (n = 100), la présence de méconium à la vulve (n = 31), et de façon fortuite lors des bains (n = 35). Le tableau clinique à l’admission était dominé par l’occlusion dans 159 (67,7%) cas. Les malformations associées visibles étaient retrouvées dans 18 cas (7,6%).
Conclusion : L’absence d’examen systématique du périnée du nouveau-né demeure réelle dans nos pratiques et la tentative de lavement par les parents était la circonstance diagnostique prédominante.

Summary
Anorectal malformations in Sub-Saharan area: what circumstances for the diagnosis?

Background: Anorectal malformations (ARM) are a large spectrum of delivery abnormalities in the distal portion of the digestive tract. They affect the quality of life of children who are carriers. The routine examination of the newborn has enabled the early diagnosis and management in developed countries. However, in Sub-Saharan Africa, delayed diagnosis makes them a common cause of neonatal intestinal obstruction. There is a lack of data regarding the circumstances of diagnosis in our country. This study aimed to analyze the diagnostic circumstances of ARMs.
Patients and methods: We carried out a retrospective study on the records of neonates with ARM, treated between January 2012 and June 2019 in two teaching hospitals centre in Abidjan. Studied variables were age at diagnosis, gender, place of birth, quality of the person who discovered the anomaly, diagnostic circumstances, subtype of anorectal malformations, functional signs, and presence of associated congenital anomalies. A delayed diagnosis was considered to be one made 48 hours after birth regardless of gender.
Results: The study included 235 cases. Male to female ratio was 1.4. Births occurred at a health centre in 192 cases (81.7%), and at home in 43 (18.3%) by traditional birth attendant. No antenatal diagnosis was made. The parents discovered the ARMs in 166 cases (70.7%). The average diagnostic time was 3,2 days. Delayed diagnosis occurred in 129 cases (54.8%). Among the 192 neonates born in health centre, 128 (66.6%) had their diagnosis made at home by their parents. The circumstances of discovery by the parents were the attempted enema (n = 100), the presence of meconium in the vulva (n = 31), and incidentally during the baths (n = 35). Predominated functional signs were abdominal distension and bilious vomiting. The clinical picture at admission was dominated by neonatal occlusion in
159 (67.7%) cases. Recto-vestibular and recto-uretral fistulae were the most common subtype of ARM. Associated congenital anomalies were found in 18 cases (7.6%).
Conclusion: Our study shows that anorectal malformations were characterized by diagnostic delay. The discovery was made by the parents in more than half of the cases. The lack of systematic examination of the newborn’s perinea remains real in our practices, and the attempted enema by the parents was the predominant diagnostic circumstance. The promotion of careful examination towards all health practitioners and traditional birth attendant will reduce this diagnostic delay. This also implies a change in the behaviour of health workers, which will improve the care of neonates.