Clinical context (No meconium passage within 24 h, abdominal distension, absent or abnormally placed anus — may have fistula to urethra/vagina/perineum; NPO, NG if distended; urgent pediatric surgery — do not dilate blindly)
First-line therapy
NPO + NG decompression if distended + urgent pediatric surgery transfer • —
Duration: Until transfer / definitive care · ABCDE; examine perineum for fistula opening, meconium staining, anal dimple; invertography/prone cross-table film at 24 h if diagnosis uncertain; NPO; NG if vomiting/distension; IV fluids; warm; urgent pediatric surgery — classify low vs high anomaly at center
Supportive care — antibiotics if perforation/peritonitis • —
Duration: Until definitive repair · Ampicillin + gentamicin ± metronidazole only if dilated bowel, perforation, or peritonitis suspected — not routine (APSA)
Clinical notes
• Recognition: no meconium in 24 h (earlier if no fistula), progressive abdominal distension, absent anal opening or stenotic membrane.
• Meconium per urethra or vagina suggests fistulous high/low anomaly — note finding but do not probe blindly.
• Primary care: NPO, NG decompression, IV fluids, prevent hypothermia; urgent surgical referral within hours.
• Do NOT: attempt blind dilatation, give oral feeds, perform contrast studies without surgical input.
