SURGICAL MANAGEMENT OF CONGENITAL CYST AT TAIL BASE AND CONCURRENT ATRESIA ANI IN A GRADED MURRAH BUFFALO CALF

Introduction: The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF).Materials & Methods: This interventional study was conducted on 40 female children born with ARM with RVF from July 2007 to June 2009 in the Department of Pediatric Surgery, Dhaka Medical College Hospital. Their age range was from 3 months to 7 years. Anterior sagittal anorectoplasty (ASARP) was done as definitive treatment of RVF. 20 out of 40 patients underwent single stage procedure and the rest underwent multiple stage procedure. Good preoperative bowel preparation and postoperative wound care were ensured for optimum outcome.Results: Mean operating time was 70 minutes in single stage and 80 minutes in multi stage definitive procedure. Average hospital stay was 10 days in single stage procedure where as 22-24 days in multi stage procedure. Partial perineal wound dehiscence occurred in two patients with single stage procedure and one patient with multi stage procedure. Wound infection was seen in two patients of single stage and also two patients of multi stage procedures. Fecal continence was good in all patients older than 3 years. Average number of bowel movement was 2-3 times daily in older patients and 2-4 in younger patients. Constipation developed in three patients with multiple stage procedure and in two patients with single stage procedure. Both groups were managed conservatively for all complications. In Dhaka Medical College Hospital, treatment cost is mostly free, so we could not compare this cost but the incidental expenses in single stage treatment was Tk. 10,000.00 and Tk. 30,000.00 in multistage treatment in three settings.Conclusion: Adequate preoperative bowel preparation, good surgical skill, proper analgesia and postoperative wound care remain the key factors to produce a cost effective excellent outcome of single stage correction of RVF.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19523

IntroductionTo our knowledge, there are no studies to date that have compared patients with isolated anorectal malformation (ARM) to patients with ARM and an associated genitourinary (GU) malformation despite a possible etiological difference between these two entities. We examined the differences in maternal and prenatal exposures and comorbidities between patients with isolated ARM and patients with ARM and associated GU malformations.Materials and methodsA retrospective cohort study of children with ARM, enrolled in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) between February 2017 and October 2019, was performed comparing those with isolated ARM to those with ARM and associated GU anomalies (GU +/- additional anomalies) as well as to those with ARM and a GU anomaly with no anomaly of any other system (GU-only). We compared the prevalence of prematurity, family history of colorectal disorders, as well as maternal and prenatal comorbidities and exposures between these two cohorts and the isolated ARM cohort.ResultsA total of 505 patients (117 with isolated ARM and 388 with ARM and associated GU anomalies) were enrolled. Of the 388 patients with ARM and associated GU anomalies, 48 had an ARM with a GU anomaly without an anomaly in any other system. There was an increased prevalence of premature births in the GU +/- additional anomalies cohort compared to the isolated ARM cohort (27 vs 14%, p=0.003). This difference was not seen in the GU-only cohort. There was no difference between the cohorts regarding prevalence of family history of ARM or maternal and prenatal comorbidities or exposures.ConclusionsPatients with an ARM and an associated GU anomaly with or without other congenital anomalies are more likely to be born prematurely compared to patients with an isolated ARM. Parents of these children should be counseled on this increased risk.

Atresia ani is a congenital defect that describes the absence of a normal anal opening. It is fatal unless a surgical correction is carried out to provide an anal opening. In female, the rectum may break through the vagina, forming a rectovaginal fistula permitting defecation via the vulva. Surgical treatment of atresia ani is indicated to save the animal’s life and to improve body weight gain. Intestinal atresia has been reported as a congenital defect in all species of domestic animals (Gass and Tibboel, 1980). Atresia ani may be caused by genetic disorders (chromosomes or transgenesis), environmental factors, or a combination of both (Cassini et al., 2005). Monsang et al. (2011) reported a case of double vulva with atresia ani in a crossbred calf. Atresia ani should be treated by a surgical operation to solve the problem, improve body weight gain, and reduce economic loss. The present report records a case of atresia ani in a crossbred cow-calf and its successful surgical correction.

Understanding the Burden of Pediatric Gastrointestinal Diseases—Does a Look From the Perspective of Inpatient Administrative Databases Help?

Anorectal malformations are congenital defects that present as a spectrum. In one extreme are malformations with the necessary anatomic structures to undergo a successful surgical reconstruction and have excellent functional results for bowel, urinary, and sexual function. On the other extreme of the spectrum, we see devastating malformations, with severe anatomic deficiencies, which will have serious consequences for life. Based on the follow-up of more than 3000 cases, we can now determine the future functional prognosis in a fairly accurate way during the first 72 h of life, based on a few relatively simple tests. Traditionally, anorectal malformations have been classified into three categories: “High,” “Intermediate,” and “Low.” Since 1980, with the advent of the posterior sagittal approach, it has been possible to see the intrinsic anatomy of these malformations directly and has become evident that this classification was misleading and useless. The new classification is based on therapeutic and prognostic factors, which means that each defect has a specific treatment and a specific functional prognosis. In addition to the specific type of malformation, it is now recognized that the characteristics of the sacrum, measured in an objective manner (sacral ratio), have an enormous influence on the functional prognosis. It is also recognized that the presence of a spinal defect called tethered cord influences the functional prognosis, although not as much as the sacrum. The field of fetal medicine and surgery has been progressing rapidly; we can now detect the most serious congenital anorectal, gynecologic, and urologic malformations in utero. In some specific cases, it is possible to surgically intervene, before the delivery, draining a massively distended vagina to avoid the demise of the baby. In addition, the early diagnosis allows the parents to make important decisions, including the need to deliver the baby in a specialized center to offer him (her) the best possible management. Modern imaging technology (MRI, Rotational CT Scan) allows us to make more accurate diagnoses, which helps in planning the surgical approach and detecting anatomic problems during the long-term follow-up of these patients. The MRI has also a big impact in re-defining the traditional anatomic concepts of the anatomy of the sphincters in normal individuals and patients with malformations. The laparoscopic approach to repair anorectal malformations that traditionally required an abdominal intervention, nowadays allows the repair of those defects in a minimally invasive fashion with many advantages for the patient. We have learned a lot about the importance of detecting and adequately treating associated malformations, including mainly urologic, orthopedic, neurosurgical, gastrointestinal, and cardiac. This encouraged us to create multidisciplinary centers to offer a more comprehensive management to our patients. The long-term follow-up of patients came with a very important revelation: children born with these defects become adults and continue suffering from diverse colorectal, urologic, and gynecologic consequences; when they look for help they feel desolated because they perceive that adult specialists do not know much about these defects. A new concept emerged: “Transitional Care.” It is a model of care that allows pediatric surgeons to interact with their adult specialists, to provide the best possible care to adults born with anorectal malformations. The recognition that at least 25% of all patients born with anorectal malformations, under the best circumstances, suffer from total fecal incontinence lead to the implementation of a Bowel Management Program, designed to improve the quality of life of those patients, by keeping them artificially clean in their underwear. Rectal mucosal prolapse is one of the most common consequences of the treatment of anorectal malformations. A recently described, new surgical approach to this problem is giving very impressive results.

Influence of anaesthetic and analgesic techniques on outcome after surgery

Objectives: To determine the frequency of congenital cardiac anomalies in patients with anorectal malformations. Study Design: Retrospective study. Setting: Department of Pediatric Surgery, Khyber Teaching Hospital, Peshawar. Period: Jan 2018 to June 2018. Material & Methods: All patients from 0 to 30 days of life both males and females (Inclusion criteria) with diagnosed anorectal malformation on clinical and radiological assessment, underwent cardiovascular work up to identify any cardiovascular disease. Patients with intersex disorders and those operated elsewhere were excluded. Mean and standard deviation were calculated for age. Frequency and percentage were calculated for gender, type of anorectal malformation, genital ambiguity, previous surgical intervention and congenital cardiac anomalies. Data was stratified for age, gender, lesion level, genital ambiguity and previous surgery to see the effect modification. Results: Out of 90 patients with anorectal malformation, there were 49 (54%) males and 41 (46%) females (M: F;1:1.19). with mean age of 7.65 ± 2.43 days. There were 39 (43.34%) patients with low anorectal malformation and 51 (56.67%) patients with high anorectal malformation. Genital ambiguity and previous surgical intervention was present in 8 (8.89%) and 11 (12.23%) patients, respectively. Congenital Cardiac Anomalies were diagnosed in 16 (17.78%) patients with anorectal malformation. Congenital Cardiac Anomalies were mostly seen in age group 1-10 days (21.95%), male children (22.45%) and high anorectal malformation (23. 52%). Conclusion: The frequency of congenital cardiac anomalies in patients with anorectal malformations was found lower than local figures. The majority of congenital cardiac anomalies associated with high anorectal malformation and male gender.

Transthoracic Exposure for Anterior Spinal Surgery

Imperforate anus is a birth defect in which the anal opening is absent. This condition develops during the fifth to seventh weeks of pregnancy and the cause is unknown. It affects about one in every 5,000 newborns and is noted to be more common among boys than girls. Imperforate anus is usually present with other birth defects such as vertebral defects, cardiac problems, tracheoesophageal fistula, renal anomalies, and limb abnormalities, collectively known as the VACTERL association. These are classified as low or high type. In the low type, in which the rectum remains close to the skin, there may be associated stenosis of the anus, or the anus may be missing altogether, with the rectum ending in a blind pouch. In the high type, in which the rectum is higher up in the pelvis, there may be a fistula connecting the rectum and the bladder, urethra, or the vagina. The diagnosis is made by performing a physical exam after birth. An x-ray of the abdomen and abdominal ultrasound can help reveal the extent of the abnormalities. Treatment is surgical creation of an opening or new anus to allow stool to pass. The type of surgery differs and depends on whether the anus ends high or low in the pelvis. In the case of a low type, an anal opening is made in a single operation, and the rectum is pulled down to the anus. For high type, surgical correction is performed in three stages. The first procedure is bringing the intestine out of the abdomen creating a stoma; the second procedure is pulling the rectum down to the anus where a new anal opening is created; and the third procedure is closure of the intestinal stoma. Here, we present a case of a 9-month-old male who was born with a high-type imperforate anus. A posterior sagittal anorectoplasty (PSARP) was done as the second of three stages of treatment. The first was an emergency sigmoid colostomy, and the third will be to close the colostomy in about 6 to 8 weeks following the PSARP.

Laryngeal clefts

This study was conducted in 46 calves to investigate the prevalence of atresia ani/atresia ani et recti in calves at Veterinary Teaching Hospital, & Department of Surgery and Obstetrics, Bangladesh Agricultural University (from June 2009-June 2011) and Shombugong area (Mymensingh District) from January 2008- December 2009. The total percentage of the affections was 23% among the surgical affections in new born calves. The frequency and location of intestinal malformations and gender distribution of affected calves were investigated. The occurrence of atresia ani/ atresia ani et recti in cross bred or indigenous bred were also studied. Atresia ani with or without other intestinal malformations was diagnosed by the Veterinarian at day 1 (25 calves), day 2 (13 calves), day 3-4 (3 calves) and day 5-8 (2 calves) after birth. The affected calves were reported to have been nursed normally immediately after birth but clinical sign became progressively worse with abdominal distension, loss of appetite and abdominal straining. There was no anal opening, but a bulge appeared at its site. Male calves were more frequently affected with atresia ani than those of female calves. The ratio of the male and female affections was approximately 5: 2. The total percentage of indigenous calves affected with atresia ani was 71.74% and the crossbred were 28.26%. Surgical correction is the only successful technique for atresia ani. The prognosis of surgical correction of atresia ani in calves was found good.DOI: http://dx.doi.org/10.3329/bjvm.v12i1.20462 Bangl. J. Vet. Med. (2014). 12 (1): 41-45

Purpose: Anorectal malformations (ARM), present in 2-5 per 10,000 live births in the general population, represent a diverse spectrum of abnormalities, and their etiology is unclear. Human and animal studies have pointed to genetic causes, so we studied patterns of heritability in a large case series. Methods: We searched our ARM database for all patients having family members with ARM or other congenital anomalies and analyzed the clinical characteristics of the proband and affected family member(s). Results: Out of 1606 patients with ARM, 24 patients (1.4%) had one or more family members with an ARM. Familial ARMs were 2.4-fold more common in girls. Certain types of ARM were more likely to be associated with a positive family history. Thus, girls with a positive family history were 2.0 (95% confidence interval, 1.5-2.7) times more likely to have vestibular or perineal fistula than those with a negative family history. Boys with a positive family history had a relative risk of 3.5 (95% confidence interval, 1.8-6.8) of having a perineal fistula. A total of 39 (2.4%) had a family member with any congenital anomaly. The male to female distribution was 1:1.3, similar to the 1:1.1 ratio for the entire series. The associated anomalies included a variety of caudal and genitourinary malformations, including sacral masses (four), gynecologic anomalies (three), and sacral anomalies (two), as well as hematologic anomalies (two), esophageal atresia, duodenal atresia, single kidney, meningocele and trisomy 21 (one each). Conclusions: Our results support a strong genetic component to ARM, with an incidence in family members of patients with ARM that is 28-70 times greater than the general population. The risk of having an affected family member is significantly increased in the presence of a vestibular or perineal fistula (females) and perineal fistula (males). Family members of patients with ARM also had a variety of caudal and genitourinary malformations. These new data allow for more informed counseling of families with an ARM and support the need for further genetic studies.

Background: Anal atresia is a congenital malformation, which often affects calves, and is related to the imperforation of the membrane that separates the endoderm of the posterior intestine from the ectodermal anal membrane. It is commonly associated with other congenital malformations and skeletal anomalies. The clinical signs generally appear in the first days of the animal's life, due to a retention of feces. The diagnosis is clinical and is based on observation, anamnesis and a physical examination of the animal. The only viable treatment is surgical. This paper aims to report 6 cases of anal atresia in bovine calves, 4 males and 2 females that were successfully treated surgically. Cases: This work reports 6 cases of anal atresia in 4 male calves and 2 female calves. Three presented total atresia (type II), one partial (type I) and in both female calves, anal atresia and rectovaginal fistula (type IV) were observed. The animals were all of undefined race. Five of the cases were from northern Tocantins, 4 males and 1 female (anal atresia with rectovaginal fistula), and 1 female (anal atresia with rectovaginal fistula) was from Valença, RJ. All animals were born active, by eutocic/natural birth, and assumed a quadrupedal position followed by the first feeding as normal. They were aged between 2 days and 6 months, and had a clinical history of abdominal distention and difficulty or inability defecating, and the females both also had a rectovaginal fistula, all cases compatible with anal atresia. Based on the patient's history and clinical examination, surgical treatment for anal reconstruction was decided upon. Postoperative treatment consisted of enrofloxacin [2.5 mg/kg - intramuscularly (IM), once daily (SID), for 5 days] and fluxinin meglumine [1.1 mg/kg - IM, SID, for 3 days] ; as well as a healing ointment which was applied to the area of the surgical wound, every 12 h, for 7 days. There were no trans-surgical complications. The animals showed progressive recovery after anal reconstruction and the stitches were removed in all cases on the 10th postoperative day, with no postoperative complications and no recurrence of any clinical signs from that moment on.Discussion: The study of congenital and hereditary changes enables the identification of their origins, can help prevent new cases and, some of them, are open to economically viable treatment and/or correction that can improve the well-being of the animal and prevent economic losses due to death or animal sacrifice, as reported in the present study. Anal atresia is the most common congenital defect of the lower gastrointestinal tract in calves, being an isolated abnormality, or associated with other malformations, especially of the distal spinal column such as the absence of a tail (perosumus acaudato), as one of the animals in this study. The clinical signs and physical examination are sufficient to establish the diagnosis, as demonstrated in this report, which is usually made in newborn animals, due to the lack or difficulty in defecation associated with no anal orifice and/or swelling in the perineal region. The treatment of choice for anal atresia is surgical, in order to construct an anal neo-orifice and thus avoid endotoxemic shock as well as providing relief and well-being for the animals. As observed in this study, when anal atresia is diagnosed early, and surgical treatment is properly instituted, the prognosis is favorable. The surgery is considered of low complexity, quick and it can be carried out in the field. Thus, from a commercial point of view, considering the costs of the procedures and the value of the calf at the end of weaning, such treatments are beneficial to the owners. In addition, the surgical treatment is essential for animal health and welfare in cases of anal atresia.Keywords: cattle, congenital defects, hereditary pathology, perosomus acaudato, surgery.

ABSTRACT: This study aimed to investigate the relationship between serum vitamin and mineral levels and congenital defects in digestive and urogenital system anomalies in calves, lambs, and kids. The study material consisted of 13 calves, 15 lambs, 10 kids clinically and radiologically diagnosed with congenital digestive and urogenital system anomalies and 10 newborn clinically healthy calves, 10 lambs, and 10 kids. Congenital defects were diagnosed by clinical and radiological examination. Blood samples were collected from all animals, and sera were extracted for biochemical analysis. Vitamins A, D, and E, calcium, phosphorus, sodium, potassium, chlorine, magnesium, copper, iron, zinc, selenium, and manganese levels were measured in serum samples. Penile urethral diverticulum in kids, atresia ani, atresia ani with vaginal fistula in lambs, and atresia ani and atresia coli defects in calves were determined. Copper levels were higher, and zinc levels were lower in kids with penile urethral diverticulum compared to the control group. Vitamin A levels were lower in lambs with digestive system anomalies compared to the control group. Meanwhile, copper levels were higher in lambs with digestive system anomalies. Vitamin A and D levels were lower in calves with digestive system anomalies compared to the control group. There was no difference in the levels of the other parameters compared to the control group. In conclusion, insufficient serum vitamin A levels may play a role in the etiopathogenesis of congenital intestinal atresia in calves and lambs. Therefore, we believe that parenteral vitamin A administration to the mother, especially in the last trimester of pregnancy in regions with continental climates and poor green vegetation, would be beneficial. Further research should be conducted to determine the role of vitamin A in the etiopathogenesis of congenital atresia ani and coli.

P-0123 - Post Operative Pain Management in Whipples' Procedure -Epidural Analgesia Versus Intravenous Analgesia