Authors
Central Child Teaching Hospital/ Baghdad, Iraq.
Abstract
BACKGROUND:
Anorectal malformation is a complex spectrum of anomalies. There are different types of anorectal malformation. The distinction can usually be made on the basis of clinical data regarding the presence or absence of a visible perineal opening or passage of meconium through the vagina or urethra.
OBJECTIVE:
To assess the validity of ultrasonography in detection of the exact anomaly in male type imperforate anus, in order to help plan the proper surgical approach.
PATIENTS AND METHODS:
A prospective study carried out between December 2017 and December 2018, at pediatric surgery department in Central Teaching Hospital in Baghdad, Iraq. Nineteen patients with imperforate anus were enrolled in this study (all were males), their age ranged between 1 day and 6 months. All patients were sent for trans-perineal ultrasound and infracoccgeal ultrasound, which were performed by using a high-resolution 11 MHz linear array transducer, in which the rectal pouch-perineal distance(P-P distance), presence or absence of recto-urinary fistula along with its précised location and the relation of the blind rectal-pouch to the pubo-rectalis muscle were obtained for a proper classification of the type of imperforate anus.US findings were compared to the operative findings which were the gold standard.
RESULTS:
The rectal pouch-perineal distance(P-P) was identified using US in all patients with a mean (27.3211) mm and SD +\- (14.78631) mm. The puborectalis muscle was identified as a hypoechoic U-shaped band in all patients along with its relation to the blind rectal-pouch. There is a statistically high significant relationship between the US and the operative findings regarding the presence and precise location of the internal fistula (P-value=0.0001).US findings showed a high sensitivity of 92.8%, specificity of 100% and accuracy of 94.7%.
CONCLUSION:
U\S whether in (Transperineal \ Infracoccygeal) approach is highly accurate, it provides an excellent imaging modality with high sensitivity and specificity in the detection of the internal fistula. U\S measurements are independent of age.
REFERENCES:
- Upadhyaya, V.D., Gangopadhyay, A.N., Srivastava, P., Hasan, Z. and Sharma, S.P. (2008) Evolution of Management of Anorectal Malformation through the Ages. The Internet Journal of Surgery, 17, 1.
- Gangopadhyay, A.N. and Pandey, V. (2015) Anorectal Malformations. Journal of Indian Association of Pediatric Surgeons, 20, 10-15.
- Samuel Webster and Rhiannon de Wreede, Embryology at a Glance, Wiley-Blackwell Publisher, UK, 2012, chapter 31, pages 70-71.
- George W. Holcomb III, Ashcraft’s Pediatric Surgery, 6th edition, Elsevier Saunders, China, 2014, chapter 35, pages 492-514
- Pena A. Management of Anorectal malformation during the newborn period. World J Surg 1993; 17:385-95.
- Alehossein M, Mollaeian M, Salamati P, Poorang Il, Sedighi A. Validity of transperineal ultrasound in infants with imperforate anus. Iran. J. Radiol 2004;43-6
- Kavalcova L, Skaba R, Kyncl M, Rouskova B, Prochazka A. The diagnostic value of MRI fistulogram and MRI distal colostogram in patients with anorectal malformations. Journal of Pediatric Surgery.2013;48(8):1806-1809.
- Kim IO, Han TI, Kim WS, et al .Transperineal ultrasonography in imperforate anus: Identification of the internal fistula .J Ultrasound Med 2000; 10: 211-216.
- Haber HP, Seitz G, Warmann SW, Fuchs J. Transperineal sonography for determination of the type of imperforate anus. AJR Am J Roentgenol 2007; 189:1525–1529.
- Han TI, Kim IO, Kim WS et al. US identification of the anal sphincter complex and levator ani muscle in neonates: infracoccygeal approach. Radiology 2000; 217: 392–394
- Hosokawa T, Comparison Between the Pouch-Perineum Distance in Neonates With a Low-Type Anorectal Malformation With and Without an Opened Fistula:Pitfall of Measuring the Pouch-Perineum Distance on Sonography, J Ultrasound in Med,2018.
- Jardosh Y, Chavda D, Vadel M, Transperineal Ultrasonography in Infants with Anorectal Malformation, International Journal of Science and Research (IJSR), (2015): 6.391.
- Choi YH, Kim IO, Cheon JE, Kim WS, Yeon KM. Imperforate anus: determination of type using transperineal ultrasonography. Korean J Radiol 2009; 10:355–360.
- Niedzielski J, Midel A. Is augmented-pressure distal colostography useful in the diagnostics of anorectal malformations? Surg Childh Intern 1998; VI, 1: 28–31
- Alehossein M, Mollaeian M, Validity of Transperineal Ultrasound in Infants with Imperforate Anus, Iran. J. Radiol., 2004.
- Sarkar A, No-fistula vs. fistula type Anorectal malformation: outcome comparative study, Journal Of Pediatric Surgery, 2018.
- Kim IO, Han TI, Kim WS, et al. Transperineal ultrasonography in imperforate anus: Identification of the internal fistula .J Ultrasound Med 2000; 10: 211-216.66. Hosokawa T,Yamada Y, Diagnostic Accuracy of Sonography for Detection of a Fistula on the Birth Day in Neonates With an Imperforate Anus: Comparison of Diagnostic Performance Between Suprapubic and Perineal Approaches, Journal of ultrasound,2017, 36-10.
- Hosokawa T, Hosokawa M, Tanami Y, et al. Comparison of diagnostic accuracy for the low-type imperforate anus between prone crosstable radiography and sonography. J JUltrasound Med. 2017; 36:1679–1686.
- Hosokawa T,Yamada Y, Diagnostic Accuracy of Sonography for Detection of a Fistula on the Birth Day in Neonates With an Imperforate Anus: Comparison of Diagnostic Performance Between Suprapubic and Perineal Approaches, Journal of ultrasound,2017, 36-10.
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