Error Traps and Culture of Safety in Anorectal Malformations

Five error traps have been identified in the management of anorectal malformations.

The first error trap is the creation of a colostomy too distal in the sigmoid colon.

The recommendation is for a colostomy at the descending colon.

The second error trap is having an inaccurate distal colostogram.

A correctly done distal colostogram should show the site of the mucous fistula, the amount of bowel length available for the pull-through, the end of the rectum or the connection to the urinary tract, whenever possible the bladder and the urethra, the tip of the sacrum, and the anal marker.

The third error trap is operating on a male patient without a Foley catheter and ignoring the hazards of the separation between the anterior rectal wall and the genitourinary tract.

The fourth error trap is attempting to dilate a true rectal stricture.

Anal dilations are not for real strictures.

The fifth error trap is not offering long-term follow-up to these patients.

Patients with anorectal malformations need long-term follow-up in colorectal, urology, and gynecology.

By avoiding these common error traps, patients will receive better care.