Anorectal Disorders Flashcards
T/F: Congenital anorectal disorders are usually isolated findings.
False. Congenital anorectal disorders are often part of other disorders, including VACTERL.
How does perineal fistula present in males?
A perineal fistula presents with a small orifice on the perineum located just anterior to the center of the external orifice, usually it is close to the scrotum. Anal dimples are prominent. Boys have a “bucket handle” malformation or “black ribbon” structure in their perineum that is a subepithelial fistula filled with meconium.
How often are other congenital anomalies found in patients with perineal fistulae?
Less than 10% of those affected have other organ anomalies.
What is the recommended management of perineal fistulae?
The defect can be surgically repaired without need for colostomy.
How does perineal fistula present in females?
It presents with a small orifice on the perineum located close to the vulva, anterior to the center of the external orifice.
What is the most common anorectal defect in males?
Rectourethral fistula
What is a rectourethral fistula?
A rectourethral fistula occurs in males when the rectum communicates with the lower (bulbar) or upper (prostatic) part of the urethra.
How does a rectourethral fistula typically appear on exam?
Most patients have a well-defined midline perineal groove and an anal dimple.
What is the recommended management of rectourethral fistulae?
A protective colostomy is required during the newborn period, with complete surgical repair later in life.
What is a rectovesical fistula?
A rectovesical fistula occurs when the rectum communicates with the neck of the bladder. The sacrum is frequently absent.
How are rectovesical fistulae managed?
Bowel function is poor in these patients, so colostomy is required in the newborn period, followed by corrective surgery later in life.
What is the most common anorectal defect in females?
Vestibular fistula
What is a vestibular fistula?
The rectum opens into the vestibule of the female genitalia immediately outside the hymenal orifice. The sacrum and sphincter tone are normal and an anal dimple is present.
What is the recommended management for vestibular fistulae?
A protective colostomy must be performed in the newborn period before definitive surgery can be done.
What is a persistent cloaca?
Persistent cloaca means that the vagina, rectum, and urinary tract meet and fuse at a common channel. There is a single orifice just behind the clitoris.
Differentiate between the presentation of females with persistent cloaca < 3 cm and those with persistent cloaca > 3 cm.
Those with short channels (< 3 cm) have a well-developed sacrum and good sphincter tone. Those with long channels (> 3 cm) have a more complex defect and typically have a poorly defined sacrum and sphincter tone.
What (2) additional anatomic abnormalities are often present in patients with persistent cloaca?
Most affected females also have an abnormally large vagina filled with mucus (hydrocolpos), and 90% also have urologic abnormalities requiring emergent attention.
What is the recommended management of peristent cloaca?
A colostomy must be performed in the newborn period followed by definitive reconstructive surgery.
What is imperforate anus?
An imperforate anus occurs when the rectum is completely closed off and does not communicate with the anus or skin.
Which chromosomal abnormality has an increased risk of imperforate anus?
Trisomy 21
What is the recommended management of imperforate anus?
Initial colostomy in the newborn period with reparative surgery later in life.
What is rectal atresia?
Patients have a normal anus and anal canal, with obstruction located approximately 2 cm above the skin level.
What is the recommended management of rectal atresia?
Initial colostomy in the newborn period with reparative surgery later in life.
What is rectal prolapse?
Rectal prolapse occurs when ≥1 layer of the rectum protrudes through the anus. It presents as a red-purple, circular protrusion from the anus.
