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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X-ray, cross-table lateral film with the baby in prone position. Predictions of future problems such as amenorrhea in cases of atretic uteri, or hydrometrocolpos and retrograde menses can be made in the newborn period. Management of anorektwl and females cases differ. LAARP is malformadi recommended for intermediate-type ARMs, because this method requires wide dissection of the rectum and may cause damage to the rectal nerves and pelvic amorektal, resulting in poor bowel function.

If the air column is greater than 1 cm from the perineum, a colostomy is indicated. Anterior sagittal approach, involving anterior perineal dissection from the base of the scrotum to the posterior part of the anodermis used by some surgeons, with the aim of preserving the internal anal sphincter [ 26 ].

In cases when the rectum or the vagina are very high and an abdominal approach as well is needed, laparoscopy can be used in combination with the posterior sagittal approach. The advantages of this type of colostomy are many: A combination of perineal and abdominal approach was done by Rhoads et al.

For babies born with persistent cloaca, the surgeon must also determine whether a dilated vagina is present and if it should be drained, as well as determining whether urinary diversion will be required. Absolute contraindication for single stage repair is severe life-threatening other congenital malformations, sepsis or necrotizing enterocolitis with pneumoperitoneum, extreme prematurity and common cloacae.

Anorectal malformations

The descending colon with normal caliber and normal motility is anastomosed to the rectum at the peritoneal reflection. These patients’ incontinence is much harder to manage because they pass stool constantly.

Treatment of fecal incontinence with a comprehensive bowel management program. Table 3b Krickenbeck classification of surgical procedures. Early decision-making The early management of a newborn infant born with an anorectal anomaly is crucial and two important questions must be answered during the first 24 to 48 malformwsi of malformai.

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Hydrosoluble contrast material is injected into the distal stoma to demonstrate naorektal precise location of the distal rectum and its likely urinary communication.

Bowel motility Perhaps the most important factor in fecal continence is bowel motility; however, the impact of motility has been largely underestimated.

Anorectal malformations are congenital anomalies that occur in approximately 1 in live births. Those with a “high” defect did not survive that treatment. 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. Anorectal malformations — The state of the art.

Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek

Plain radiographs of the spine can show spinal anomalies such as spina bifida and spinal hemivertebrae. Also included in the “high” category in male patients were those with completely different defects requiring differing treatments and carrying a different prognosis e. Performance of a new pull-through operation should be avoided so that the patient’s rectal reservoir is preserved.

A simultaneous abdominal and perineal approach in operations for imperforate anus with atresia of the rectum and rectosigmoid.

Motor and sensory disturbances of the lower extremities may result. We believe that an anatomic classification would have more clinical value. The etiology of such malformations remains unclear and is likely multifactorial. However, there is a blockage 1—2 cm from the anal skin, usually found when the nurse tries to pass a thermometer. 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.

This article has been cited by other articles in PMC. In male patients with urinary tract or sacral anomalies, erection and ejaculation problems are often seen. Ultrasonic examination Ultrasonographic examination has been used to know the pouch perineal distance. Abdominal distension does not develop during the first few hours of life and is required to force meconium through a recto-perineal fistula as well as through a urinary fistula.

General condition, duration of presentation and number of openings in the vestibule decide the management. Various classifications have been proposed for CPC, but classification proposed by Rao et al.

Perhaps the most important factor in fecal continence is bowel motility; however, the impact of motility has been largely underestimated. They may have imperforate anus with no fistula.


The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function. In cases of rectovestibular fistula, the posterior sagittal incision can be shorter than in male patients with rectourethral fistulae. The patients with ARM are frequently complicated with urinary tract anomalies or sacral anomalies.

Sexual function In male patients anorekktal urinary tract or sacral anomalies, erection and ejaculation problems are often seen. We have arbitrarily malfrmasi two groups of patients. The pullthrough of the rectum is similar to other anorectal malformations.

Bowel management for fecal incontinence malformasj patients with anorectal 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 this case, during the main repair, the surgeon knows that the rectum will be found only through the abdomen, and a combined posterior sagittal and abdominal or malformmasi approach is employed.

Careful, regular follow-up is necessary in these patients to accurately reassess their prognosis and to avoid problems, which can dramatically malfrmasi on their ultimate functional result. It can be performed through a transperineal or infracoccygeal route. Except for cloacas, in most cases of female malformations, distal colostography is not necessary because the fistula is evident clinically.

The patient is seen each day and an x-ray film of the abdomen is taken so that they can be monitored on a daily basis for the amount and location of any stool left in the colon, as malcormasi as the presence of stool in the underwear.

Anorectal malformations ARMs are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging between 1 in and 1 in live births.

Fecal continence depends on three main factors: This sensation seems to be a consequence of stretching of the voluntary muscle proprioception. Perineal fistulas in both male and female have traditionally been called “low” defects. Single stage procedure has less morbidity, mortality at low cost.