Sunday Ehigiator in this report narrates how a baby, Esther Akwanga, born without anus, a rare birth defect called anorectal malformation, which prevented her from stooling, got treated for her condition after an encounter with ‘The 700 Club’, through its humanitarian arm called Operation Blessing (OB)
Esther’s plight
Life can sometimes be unfair and cruel, especially when you are not prepared for its contingencies. It is often asked ‘Why do bad things happen to good people?’ This was the case of Yohanna Akwanga, a Police Inspector who had devoted his life to serving his country.
As he looked forward to having his first child after getting married to his wife years earlier, little did he know that he would be having a baby who can’t defecate through her anus (Anorectal Malformation) because she had no opening.
Even worse, her intestines, liver, and other organs of her body protruded from her belly through her belly button. This was Esther’s case.
When Esther was born, the doctors needed to perform emergency surgery to close her abdomen. Her father had to clean out his bank account to cover the cost of the surgery. However, she needed two more corrective surgeries to enable her to pass feces through her anus.
A quest to save Esther
The cost of making sure baby Esther lived like every other normal child placed a lot of strain on her parents. Her father who wasn’t earning much from the police force was now confronted with the challenge of paying the sum of N632,000 for the surgery of his new infant.
As the days went by, he became more confused as to what to do. Esther’s father was faced with raising the sum of #632,000 for the surgery he couldn’t afford even after liquidating his account. He not only liquidated his account but had obtained loans that he had not paid back.
The Joy of fatherhood was beginning to elude him as he couldn’t watch his daughter go through such an excruciating and traumatic experience. He sought help from friends and colleagues, family members weren’t also excluded, but all he could raise wasn’t anything sufficient to perform the surgery.
Encounter with ‘700 Club’
In his quest to save his daughter’s life, he came across the 700 Club and narrated his ordeal. The 700 Club through its humanitarian arm called Operation Blessing took it upon themselves to make sure they did all they could to save Esther’s life.
The 700 Club, therefore, had crowdfunding for baby Esther through her social media handles and within 24 hours the money was raised. Both surgeries on baby Esther were successful, and now she can pass feaces through her anus. Esther is doing very fine. Baby Esther indeed is grateful because people rallied around her to give her a better life.
About ‘Anorectal Malformation’
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) defined anorectal malformations as birth defects of a child’s anus or rectum that interfere with the normal passage of stool.
According to NIDDK, the anus may be missing for children with anorectal malformations, blocked by a thin or thick layer of tissue, or more narrow than normal. “In rare cases, the anus may be normal while the rectum is blocked or narrowed.”
Many children with anorectal malformations have a fistula, or abnormal passage, between the rectum to another part of the body, such as the perineum, (the skin between the anus and the sex organs), urethra or bladder, or the vagina. In some children with anorectal malformations, the rectum and the urinary tract have the same opening. This abnormality is called a cloaca.
Data
According to the National Center for Biotechnology Information (NICB), anorectal malformations occur approximately in 1 in every 5000 live births. They are slightly more common in males (1.2 to 1).
“The majority of male patients with anorectal malformation have some form of connection to the urinary system, or a recto-urethral fistula (approximately 70% of this patient population). The most common type of anorectal malformation in female patients is a recto-vestibular fistula.”
Causes
While a specific cause of anorectal malformations is not known, genetic factors likely play a role in their development. The incidence of having a second child with anorectal malformation is approximately one per cent, according to the NICB.
The NICB equally revealed that there were several genetic syndromes with an increased incidence of anorectal malformations such as the Currarino triad which exhibits autosomal dominant inheritance, and patients with trisomy-21 have a known association with anorectal malformation without fistula.
“Approximately 95% of patients with trisomy-21 have anorectal malformation without fistula compared to only 5% of all patients with anorectal malformations.”
There is also some data to suggest environmental factor exposures may be related to the development of anorectal malformations such as in vitro fertilization, thalidomide exposure, and diabetes. Animal models have also shown exposure to trans-retinoic acid, and ethylene thiourea correlates with anorectal malformations.
Diagnosis
The majority of patients with anorectal malformations receive their diagnosis as newborns. In addition to a perineal/anal examination, which is mandatory, a full physical newborn examination in a patient with an anorectal malformation includes listening to heart sounds to see if a murmur can be auscultated, examining the limbs for any anatomic abnormality, and a full genitourinary exam.
For an anus to be normal, it should be in the correct location and the proper size, based on age. The normal size anus of a full-term infant is a 10 to 12 Hegar dilator (an instrument used to size the anus), and the size of a 12-month-old should be about a 15 Hegar dilator.
The basis of the correct location is the anal opening being in the center of the anal muscle complex. The position of the anal opening to the muscle complex cannot always be discerned in the clinic and often requires an examination under anesthesia.
The perineum should also be thoroughly evaluated by paying attention to features such as the development of the buttocks, the presence of a gluteal fold, and the examination for any type of opening or orifice on the perineum.
In female patients with anorectal malformation, a thorough vaginal exam should also take place, taking care to note the number of openings on the perineum. These physical exam features can help give clues as to the type of anorectal malformation.
Treatment and management
For patients with perianal fistulas, a repair can be performed in the neonatal period if the surgeon is comfortable with the procedure, and there are no other anomalies that would preclude anesthesia such as a cardiac defect.
The clinician can also delay the repair if the fistulous tract is large enough to perform dilations with a Hegar dilator and stool evacuation can be reliable. The same dilation strategy works for a female patient with a rectovestibular fistula as the anatomy can be challenging in the neonatal period, and dilating can allow the child to grow and improve the ease of surgical intervention.
For either patient population, it is crucial to ensure that stool is decompressing well with the dilation management, and the child is not becoming distended. If being managed with dilations, the surgical repair should occur at approximately 3 months of age.
This way, the defect can undergo correction before transitioning to solid food, reducing the risk of the development of constipation leading to rectal dilation that would impact function.
Surgical repair of these malformations is generally through a posterior sagittal incision, and the abdominal entry is not necessary.
700 Club reacts
Someone once said, “Life itself has no meaning except for its impact on others.” Speaking briefly with THISDAY about the development, The 700 Club said it seeks to be the voice and hands of hope to many cases that seem hopeless.
“But we are not able to do this without the help of people we call ‘Partners’. Baby Esther indeed is grateful because people rallied around her to give her a better life. You too can become a partner with the 700 Club to touch lives; to partner kindly send ‘partnership to 08102744535’. Thanks.”
Esther’s parents react
Speaking with THISDAY, Yohanna Akwanga, Esther’s father expressed his immense gratitude to the 700 Club for carrying out the corrective surgeries on his daughter through its humanitarian arm- Operation Blessing.
He was so thrilled to see his daughter now able to live like every normal child. He repeatedly offered prayers for the 700 Club, even as Esther’s mum also couldn’t curtail her joy as she was all filled with smiles. They are both indeed very grateful for the immense show of love toward their daughter.
