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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Bowel movement pattern prior to potty-training may give an important clue as to the child’s potential for continence. If the common channel is less than 3 cm, the posterior sagittal approach without an abdominal approach can be used to repair the defect. Open in malformassi separate window. Laparoscopic repair of high imperforate anus. Two openings only, indicate two extremely rare clinical entities, namely a recto vaginal fistula, or a blind ending rectum with no fistula.
Those that survived most likely suffered from a type of defect that would now be recognized as “low”. Furthermore, an internal sphincter saving technique has maflormasi devised when performing the posterior sagittal approach. Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation.
The patient feels the peristaltic contraction of the rectosigmoid that occurs prior to defecation. If the patient’s malflrmasi is of the type pointing to a good prognosis such as vestibular fistula, perineal fistula, rectal atresia, rectourethral bulbar fistula, or imperforate anus without fistula, one should expect that that child will have voluntary bowel movements by the age of 3.
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.
Patients who have undergone abdominoperineal operations for imperforate anus that included resection of the rectum suffer from a tendency to have diarrhea due to a lack of a rectal reservoir. It seems that patients can perceive distention of the rectum but this requires a rectum that has been properly located within the muscle structures. Urinary function The patients with ARM are frequently complicated with urinary tract anomalies anoreital sacral anomalies.
Comparing the results of reported series has always been a problem with anorectal malformations because different surgeons use different terminology when referring to types of imperforate anus. Approximately, half of children with ARM have associated anomalies.
Published online Jul When performing the colostomy in the newborn, the distal bowel should be irrigated to remove all of the meconium. Both the urinary tract and the distended vagina may need to be dealt with in the newborn period to avoid serious complications.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Plain radiographs of the sacrum in the anterior-posterior and lateral projections can demonstrate sacral anomalies such as a hemisacrum and sacral hemivertebrae. Once the constipation is managed, they become continent. Table 1 Classification of non-syndromic anorectal malformations ARM.
So, the actual impact of tethered cord itself on their functional prognosis is unclear. Anorrektal still the fecal and urinary incontinence can occur even with an excellent anatomic repair, mainly due to associated problems.
Male newborns with rectoperineal fistula do not need a colostomy. This voluntary contraction occurs only in the minutes prior to defecation, and these muscles are used only occasionally during the rest of the day and night.
For patients with cloaca, functional prognosis with regard to achieving fecal continence depends on the complexity of the defect and the status of the spine and sacrum.
On the other end of the spectrum, a child who suffers from fecal incontinence passes stool constantly without any evidence of pushing or feeling. MRI is considered superior to CT scan because of excellent soft tissue characterization, multiplanar imaging, and lack of ionizing malforamsi. The program, although simplistic, is implemented by trial and error over a period of one week. Holschneider AM, Hutson J, editor. High imperforate anus was usually treated with a colostomy performed in the newborn period, followed by an abdomino-perineal pull-through some time later in life, but surgeons lacked objective anatomic guidelines.
Anorectal qnorektal, cloaca, continence, imperforate anus.
The presence of a megarectum prior to the pull-through does correlate with postoperative constipation. After the baby is born, an intravenous line is placed for fluids and antibiotics, and a nasogastric tube is inserted to keep the stomach decompressed to avoid the risk of vomiting and aspiration.
Waiting 16—24 hours for enough abdominal distension to demonstrate the presence of a rectoperineal fistula or rectovestibular fistula applies to females as well. Bowel management for fecal incontinence in patients with anorectal malformations. Hydrostatic pressure under fluoroscopic control is required. The noninvasive nature and no radiation exposure are the main advantages, but it is highly observer dependent. The functional results after surgical correction of ARMs are often assessed by a manometric study, neural electrophysiological studies, magnetic spinal stimulation, and fecoflowmetry.
Complex vaginal mobilizations are often required and frequenly a vaginal replacement with anoreektal intestine or colon is necessary. The repair of persistent cloacas represents a serious technical challenge that should be performed in specialized centers by pediatric surgeons dedicated to the care of these complicated patients [ 22 ].
Depending on the amount of colon resected, the patient may have anoretal stools. The posterior approach and direct visualization of the anatomy have allowed us to learn about important features. Newer imaging modalities and advances in radiological technique have made it possible to exactly delineate the site of rectourethral fistula.
Untethering of the cord is indicated in the neurosurgical literature to avoid motor and sensory problems.