A Death Resulting from Imperforate Anus in the Newborn: A Case Report.

Korean J Leg Med. 2004 Oct;28(2):78-82. Korean.

Forensic medicine Divsion Forensic medicine Department National Institute of Scientific Investigation, Korea. cheyys@unitel.co.kr

Congenital anomalies of the anus and rectum are relatively common. Minor abnormalities occur in approximately 1 per 500 live births; major anomalies occur in 1 per 5000 live births. Among the various anomalies associated with rectal abnormalities are malformations of the urinary tract and esophagus and, less often, the small bowel. The most useful clinical classification categorized lesions by whether the rectum passes through the puborectalis muscle sling. High lesions fail to pass through this muscle complexes and low lesions traverse this muscle complex. The lesions in the spectrum covered by the term imperforate anus rarely are fatal, although some associated anomalies can be life threatening. However, in some lesions without any type of fistula may be fatal per se, unless the necessary fecal diversion is not made. Routine newborn examinations usually detect anorectal anomalies early in life. Some types of malformations are less readily detected. In newborns, failure to pass meconium within the first 24 hours of life usually prompts an examination of the perineum but delayed presentation is common in areas where access to medical care is unavailable. The authors report a male newborn who died of the high type of anorectal anomaly without fistula in fourth day of life, because the doctor did not recognize the anomaly of the newborn. We believe that the forensic examiner should make medical doctors alert by notifying them that their trivial mistakes can cause mortal results.

Key Word : Imperforate anus, Anorectal anomaly, Newborn