Anorectal malformations Flashcards
Most common anorectal malformation
Imperforate anus
Most important association with imperforate anus in males and females
Fistula b/t distal colon and urethra in boys and vestibule of vagina in girls
Incidence in children
1:5000 live births
Rectal and anal anomalies- gender differences
Rectal in boys
Anal in girls
Aetiology
Unknown
Defect in cloacal development
Clinical presentation
Intestinal obstruction
Not passing meconium
Examination of perineum (4)
Fistulas
Sensation
Orifices
VATER associations
Exaplanation of meconium in urine
rectourethral fistula
Reason for incontinence
Impaired function of sacral nerves/muscles
Number of orifices and defect
1= cloacal- common opening for anus/vagina/urethra
What are VATER association
Vertebral Anus TOF Esophageal Renal, radial
How to classify
Relationship to puborectalis (levator ani)–>supralevator, intermediate, transelevator. The with fistula or no fistula.
Management of rectal anomalies
Colostomy and later resconstruction at 6-12 months
Management of anal anomalies
Rarely need colostomy
Divide the fistula and bring through the puborectalis
Investigations
Xray spine
Micturating urethrocystogram
Pelvic xray
What to look for on Xray spine
Hemivertebra
Sacral agenesis
Importance of micturating cystourethrogram
To look for fistula
Vesicoureteric reflux
Complications
Anal stricture Sloughing of rectum Redundant mucosa Abscess Recurrent fistula Stenosis, prolpase of colostoy Reflux, stenosis, UTI
Type 1 defects
Thin membrane over anus
Type 2 defects
Pouch is
Type 3 defects
Blind pouch >1.5cm from anal dimple
Type 4 defects
Atresia of rectum with normal anus
