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.
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This is the best way to demonstrate a recto-urinary communication, and to determine the real height of the rectum.
Urinary tract infections are also avoided, 3 it is relatively easy to wash and clean the part of the colon distal to the colostomy, 4 distal colostograms are easy to perform, 5 the sigmoid loop is kept distal to the colostomy which provides enough length to reach the perineum during the definitive pull-through procedure, 6 the separated stomas prevent spillage of stool from proximal to distal bowel, which avoids impacted distal stool and urinary tract infections, 7 there is a low incidence of prolapse with this technique.
Voluntary muscle structures In the normal patient, the voluntary muscle structures are represented by the levators, muscle complex, and external sphincter. They occur in approximately 1 in live births. Operative Management of Anomalies in Male.
Posterior sagittal anorectoplasty has become the standard of care for dealing with ARM. Systematic review and meta-analysis. Clinical inspection of the buttocks is important.
Pena A, Levitt M. Important technical considerations and new applications.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Most patients who undergo repair of an ARM suffer from variable degrees of fecal incontinence, depending upon the type of anomaly, associated anomalies and the effectiveness of corrective procedure. Plain radiographs of the sacrum in the anterior-posterior and lateral projections can demonstrate sacral anomalies such as a hemisacrum and sacral hemivertebrae.
Anorectal malformations comprise a wide spectrum of diseases, which can affect boys mzlformasi girls, and involve the distal anus and rectum as well as the urinary and genital tracts. The posterior sagittal approach is an ideal method of defining and repairing malformazi anomalies. Antenatal diagnosis of an isolated ARM is rare.
Once the rectum is completely mobilized, a perineal body is constructed, and the rectum is placed within the limits of anorekgal sphincter mechanism [ 21 ].
Traditionally, to evaluate the degree of sacral deficiency, the number of sacral vertebral bodies were counted. Imperforate rectum; a new surgical technique. Diagnostic methods The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for malformsai anomalies. The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function.
The surgical approach to repairing these defects changed dramatically in with the introduction of the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and genitourinary tract [ 1 – 6 ]. However, the results of this approach are difficult to compare with those of other methods because terminology and classification are not consistent [ 3233 ].
A contrast enema is helpful in differentiating these two groups of patients. Fecal and urinary incontinence can occur even with an excellent anatomic repair, due mainly to associated problems such as a poorly developed sacrum, deficient nerve supply, and spinal cord anomalies. The descending colon with normal caliber and normal motility is anastomosed to the rectum at the peritoneal reflection. Pediatric Surgery and Anoremtal Finally, without fecal diversion, there is the risk of dehiscence and infection.
Pouch colon also requires abdominal approach.
Perineal fistula Perineal fistulas in both male and female have traditionally been called “low” defects. Biofeedback therapy was reported to be a simple and safe method for treating children. Loss of the rectal reservoir could lead to a worse problem of incontinence with a patient who now has diarrhea. Perianal dissection towards the laparoscopic light source favours accurate placement of a trocar to pull the rectum through the external sphincter muscle complex.
Presentations of pelvic pain or amenorrhea as teenagers should prompt the assumption of anomalous gynecologic structures.
In selected cases, a primary PSARP or a primary anterior sagittal anorectoplasty can also be performed. Once the constipation is managed, they become continent. This study is vital in determining the anatomy so the definitive repair can be planned.
The anorectal defect of imperforate anus without fistula may also be demonstrated with this radiologic evaluation. Advances in the imaging techniques with improvement in knowledge of the embryology, anatomy and physiology of ARM cases have refined diagnosis and initial management. Table 1 The Wing spread conference classification For instance, rectovaginal fistula are almost nonexistent, in retrospect it seems that most of the previously reported “rectovaginal fistula” cases were misdiagnosed cloacas.
Laparoscopic repair of high imperforate anus. The contrast material usually fills the proximal urethra and bladder through the fistula. This x-ray on rare occasion may show the column of air in the distal rectum to be within 1 cm of the perineum, and if this is the case, the baby can be treated like those with a recto-perineal fistula, and a newborn perineal operation can be performed. Orphanet J Rare Dis. The presence of three openings, with the anus not being at its normal site is indicative of either a perineal fistula, formerly called the anterior perineal anus.
A simple anoplasty malfirmasi the stenotic orifice and relocates the rectal orifice posteriorly within the limits of the sphincter complex. A more objective assessment of the sacrum can be obtained by calculating a sacral ratio.
If catherization is not performed, overflow incontinence occurs. Definition 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 and genital tracts. This anomaly has an excellent prognosis and therefore complications that could affect future continence must be anore,tal.