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IMPERFORATE ANUS REPAIR
Category: Child Health
Abstract : Imperforate anus : Routine inspection of a newborn should note the position and
patency of the anus. Anorectal malformations range from slight anterior
displacement of the anal opening to a completely imperforate anus. Many children
with imperforate anus have an abnormal sacral progression as well as internal
fistulas between the rectum and the genitourinary structures. All children with
Imperforate anus : Routine inspection of a newborn should note the position and
patency of the anus. Anorectal malformations range from slight anterior
displacement of the anal opening to a completely imperforate anus. Many children
with imperforate anus have an abnormal sacral progression as well as internal
fistulas between the rectum and the genitourinary structures.
All children with
an anorectal malformation are predisposed to constipation. A newborn with
imperforate anus should undergo plain radiography 12-24 hours after birth to
assess the distal extent of bowel gas.
Preoperative workup for
imperforate anus is focused on the proximity of the distal rectum to the anal
skin and sphincter complex. Lateral radiography with the child in a prone
position, invertography, may be helpful in classifying the imperforate anus.
Many newborns with imperforate anus have a fistulous tract to the skin or
genitourinary system. Low lesions that have a fistulous connection between
perianal or perineal body skin and rectum may be primarily repaired with a
perineal anoplasty. If the distal rectum is several centimeters above the anal
skin or has a fistula to the vagina or urinary bladder, the imperforate anus is
classified as intermediate or high. In intermediate or high imperforate anus,
colostomy is performed in the newborn period.
Following colostomy for
intermediate or high imperforate anus, the infant undergoes a staged repair of
the imperforate anus to pull down the rectum into the center of the anal
sphincter complex. Continence has been achieved with both anterior and posterior
approaches. Currently, the most widely performed procedure is a posterior
sagittal anorectoplasty as described by Pena in 1998. Outcome is dependent upon
the precision of the surgery, the severity of the sacral and perineal
musculature anomaly, and the degree of colonic dysmotility.
Anorectal
malformations are part of the VACTERL (vertebral, anal, cardiac, tracheal,
esophageal, renal, limb) association of congenital anomalies. Diagnosis of an
anorectal malformation requires an investigation for other associated midline
anomalies. Cardiac echocardiography, renal and sacral ultrasonography, and plain
radiography of the vertebrae and radii are recommended. Because esophageal
atresia with tracheoesophageal fistula is part of the VACTERL spectrum, any
infant with imperforate anus and respiratory distress should undergo full airway
evaluation.
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