Acute anuric renal failure in an infant with systemic candidiasis.

normal and yet be severely stenosed. The normal passage of meconium and stools is not a reliable guide to the state of the anus, as a stenosed anus will often allow meconium and the soft stool of the newborn to escape. Similarly a rectal thermometer can usually be easily introduced into the rectum in these cases. The technique of anal examination in the newborn is easy. The anus should first be inspected and then palpated. The little finger, well lubricated, should be used. The finger is inserted into the anus, pad first, very slowly and very gently. The normal anus will stretch as this is done and in most cases a little finger can enter the rectum. However, the examiner's finger may be too big or, as in the case of a very small baby, it may obviously be unwise to over dilate and injure the anus. With practice all degrees of anal stenosis can be excluded without the finger tip entering the rectum. During the palpation two points in particular should be noted. Firstly, the absolute size of the anus. More important than this is the suppleness or otherwise of the canal. A rigid anal canal is an abnormal one. The anus is easily amenable to examination in the newborn. If there is any doubt that there is even a slight element of stenosis an expert surgical opinion should be urgently obtained.