Anomalies Anorectal Flashcards
Anomalies Anorectal
Occur in 1\4000 neonates, male > female , most common defect in boys is a rectourethral fistula, most common defect in girls is rectovestibular fistula
Low type problem
Stenosis
High type problem
incontinence
Types of imperforate anus
- Low types.
- Inter mediate.
- High type.
Clinical features: examination of:-
Perineum
❖ Look for presence of anus , its size & site
❖ Look for presence of an anal dimple
❖ If there is an impulse on crying at the site of the anus , it denotes a low a normal
❖ In ectopic anus, there is a subcutaneous fistulous tract full of meconium .
❖ Meconium at the tip of the penis denotes a fistula to the bladder or urethra .
Abdomin
There may be evidence of intestinal obst.
General exam.
To exclude associated congenital Anomaly.
Investigation
Plain abdominal X – ray in the inverted position (invertogram).
The distance between radio opaque mark & the distal gas shadow is
Measured If the distance > 1cm —– high anomaly If the distance < 1cm —– low anomaly
Urine is examined for the presence of meconium , if present this denote a fistulous communication
Treatment
- All ano rectal anomalies can be corrected by posterior sagittal
- Approach with or without laparotomy
Persistent cloaca
A defect in which rectum, vagina, urinary tract meet & fuse into a single common channal & absence of hymen, the length of common channel varies from 1 – 7 cm .