ABSTRACT
Children with Anorectal malformations (ARMs) have a degree of sacral hypo development, with the ratio varying between 0 and 1.0. A ratio of less than 0.4, for example, represents a poor functional prognosis. With the knowledge of the type of ARM, the sacral ratio, and the status of the spine, the clinician can make a good prediction of bowel control. These three factors when assessed together comprise the ARM continence index. Some surgeons have proposed a primary repair of all ARMs during the neonatal period without a colostomy. This approach has the potential of avoiding the morbidity related to the formation and closure of a colostomy. Before the definitive repair, a distal colostogram is performed. It is the most accurate diagnostic study to define the anatomy of an ARM. The final functional result of whether a child has voluntary bowel movements can be predicted based on the precise anatomic diagnosis and status of sacrum and spine, called ARM Continence Index.
