Malformasi Anorektal. Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary. Anorectal malformations (ARMs) are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging.
|Published (Last):||27 December 2012|
|PDF File Size:||20.55 Mb|
|ePub File Size:||18.81 Mb|
|Price:||Free* [*Free Regsitration Required]|
Performance of a new pull-through operation should be avoided so that the patient’s rectal reservoir is preserved. A conservative approach has been advocated for ARM patients with ma,formasi tethered cord.
OEIS Omphalocele, exstrophy, imperforate anus, and spinal defects. After assessment of associated anomalies the child can be taken for a protective colostomy, followed by delayed repair later or a single staged definitive procedure can also be performed in selected cases.
In addition, many patients had undergone a abdominoperineal pull-through at another institution to repair a “rectovaginal fistula,” and years later had been referred because of fecal incontinence.
Furthermore, patients may have other spinal anomalies besides tethered cord such as syringomyelia and myelomeningocele. Anal canal Exquisite sensation in normal individuals resides in the anal canal. After colostomy closure, severe diaper rash is common because the perineal skin has never before been exposed to stool. The fistula and lower part of the rectum are carefully dissected to permit mobilization of the rectum for backward placement within the limits of the sphincter complex.
Bowel management for fecal incontinence in patients with anorectal malformations. When performing the colostomy in the newborn, the distal bowel should be irrigated to remove all of the meconium.
Levitt MA, Pena A. Table 2 Pena classification Imperforate anus and cloacal malformations.
Two openings only, indicate two extremely rare clinical entities, namely a recto vaginal fistula, or a blind ending rectum with no fistula.
Direct measurement between the gas-filled gut and the skin of the anus by placing a radiopaque marker on the skin is made. We have learned that approximately one third of our patients have obstructed Mullerian structures which can lead to severe problems resulting from retrograde menstruation.
Table 3b Krickenbeck classification of surgical procedures. Occasionally, the fistulas are big enough to decompress the gastrointestinal tract, and may be dilated to facilitate fecal drainage until the baby is older and a definitive repair is performed.
Anorectal Malformations in Children: There has been marked improvement in survival of such patient over the last century. Anorectal malformations ARM represent a spectrum of abnormalities ranging from mild anal anomalies to complex cloacal malformations.
A rectourethral fistula can be treated without an abdominal approach, but a rectobladderneck fistula always requires the abdomen to be entered either with laparoscopy or laparotomy.
In the male, besides the absent anus, a note must be made of the anal pit. If the baby growing well, the repair can be performed at 1—2 months of age.
A spinal ultrasound in the newborn period and up to age 3 months at which time the sacrum becomes ossified can look for evidence of a tethered spinal cord and other spinal anomalies.
At two weeks postoperatively, anal calibration is performed, followed by a program of anal dilitations. When evaluating the results of the treatment of anorectal defects, we feel that one cannot group patients according to the traditional nomenclature into “high,” “intermediate,” and “low” defects, as malformations classified in a same group can have different treatments and different prognoses.
Sexual function In male patients with urinary tract or sacral anomalies, erection and ejaculation problems are often seen. Infracoccygeal route can directly demonstrate the puborectalis as a hypoechoic U-shaped band.
The contrast material usually fills the proximal urethra and bladder through the fistula. A combination of perineal and abdominal approach was done by Rhoads et al. Long-term outcomes of anorectal malformations. Fecal continence Fecal continence depends on three main factors: National Center for Biotechnology InformationU. The antegrade continence enema procedure: See Orphanet J Rare Dis.
Reoperations in anorectal malformations. The radiologic evaluation of anorekgal newborn with imperforate malfoormasi includes an abdominal ultrasound to evaluate for urologic anomalies.
Prognostic factors include the quality of the sacrum, the quality of the muscles, and the length of the common channel. Long-term growth and development Very few long-term prospective studies have been performed to know the overall growth and development of ARM patients.
Voluntarily, the normal individual can relax the striated muscles which allow the rectal contents to migrate down into the highly sensitive area of the anal canal. The length of this common channel can range from 1 to 10 cm. There is a wide spectrum of presentation ranging from low anomalies with perineal fistula having simple management to high anomalies with complex management.
Episodes of soiling are usually related to constipation, and when constipation is treated properly, the soiling frequently disappears. Newborns with severe anatomical malformations with associated anomalies, long duration hospital stay and multiple surgical interventions may negatively influence growth and development within the first 2 years of kalformasi.
This has tilted the balance in favor of single stage repair of appropriately selected cases, as most feared complication of single staged repair like trauma to urinary tract can be avoided.
Voluntary sphincter muscles, anal canal sensation, and colonic motility. Also included in the “high” category in male patients were those malforasi completely different defects requiring differing treatments and carrying a different prognosis e. Before the definitive operation, a pressured distal colonogram and voiding cystourethrogram should be performed to reveal the site of rectourethral fistulas.
But it should be noticed that this approach might damage the vesical nerve plexus when anoreektal rectourethralfistula is dissected up to its junction with the urethra.
If catherization is not performed, anprektal incontinence occurs. Untethering of the cord is indicated in the neurosurgical literature to avoid motor and sensory problems. It can be performed through a transperineal or infracoccygeal route.