Cases Of Anorectal Malformations Research Articles

A case of anorectal malformation with human tail

A case of anorectal malformation with human tail

Health literacy and health-related quality of life in patients with anorectal malformations: A comparison between a charity hospital in Honduras and a tertiary care center in the United States

Background/purposeWe conduct an annual medical mission to Hospital Ruth Paz para Niños Quemados y Cirugía Pediátrica in Honduras to operate on cases of anorectal malformations (ARM). To improve our knowledge of these patients, we compared their health-related quality of life (HRQoL), and the health literacy of their caregivers from this hospital and ours in the United States. MethodsThe BRIEF Health Literacy Screen (BHLS) and Pediatric Quality of Life Inventory 4.0 (PedsQL) were used, respectively, to assess the health literacy and HRQoL of their guardians. All patients scheduled for an ARM-related operation in October 2016 were eligible for inclusion, and a matched population was selected in Nationwide Children’s Hospital, Columbus, Ohio. ResultsThe sample comprised 127 patients, with 22 from Honduras and 105, the US. About 13.6% and 80% of Honduran and American caregivers, respectively, had adequate literacy. Honduran and American caregivers of patients aged 12 months and below rated the HRQoL of their children at 87 and 82, respectively; aged between two and four years, at 84 and 77; aged between two and four years, at 85 and 79; and of teens, at 59 and 66. For adults, the rate was 71 and 77 in Honduras and the US, respectively. ConclusionAlthough health literacy is extremely low in the Honduran group, its HRQoL was comparable to that of its American counterpart. Improving health literacy by educating caregivers could be an additional goal for medical missions in the future. Level of EvidenceLevel III

A Case of Anorectal Malformation With Idiopathic Rectal Perforation in a Neonate

A Case of Anorectal Malformation With Idiopathic Rectal Perforation in a Neonate

Management of anorectal malformation without ligation of fistula: An approach preventing posterior urethral diverticula

ObjectiveThe posterior urethral diverticulum is a common urologic complication requiring reoperations in anorectal malformation cases (ARM). We present a series of 24 cases of male ARM managed without ligation of fistula. Material and methodsA prospective study was conducted between July 2010 and June 2012 including male neonates with ARM, where rectobladder neck and rectoprostatic fistula were approached by the abdominal route. The fistulous tract was dissected to the distal-most possible length and was excised flush with the urethra without its ligation. A per-urethral catheter was placed in situ. A record was made of any features of urinary leak and a micturating cystourethrogram was performed at the 1-year of follow-up. ResultsTwenty-four cases of ARM, 16 with rectobladder neck fistula and eight cases with rectoprostatic fistula were included. Of these, 12 had single-stage primary abdominoperineal pull-through and 10 were managed by primary posterior sagittal anorectoplasty. Two cases with colostomy during the neonatal period were managed by laparoscopic assisted anorectoplasty at 6 months. None of the cases had a urinary leak during the postoperative period. All had a normal micturating cystourethrogram at 1 year. ConclusionsThe approach of dividing fistula without ligation may prevent posterior urethral diverticula, but larger long-term follow-up studies are needed.

Congenital Pouch Colon: A Rare Variant of Anorectal Malformation: Histopathological Perspective with Brief Review of Literature

Congenital pouch colon is an extremely rare variant of anorectal malformation (ARM) in which all or part of colon is replaced by a pouch like dilatation that communicates distally with the urogenital tract by a large fistula. Congenital pouch colon differs from normal colon structurally, histologically and functionally. The incidence of congenital pouch colon among all cases of anorectal malformation in northern India has been reported to be between 5-10%. Rest of the India and around the globe handful of documented case reports was noted. The mortality from congenital pouch colon has decreased from 40% to 15%, if identified and managed properly. Herein, we report a case of 10 days male child presented with congenital pouch colon in view of a rare congenital anomaly. We enlighten the detailed histopathological findings in this case as there is paucity of literature of congenital pouch colon.

Fecaloma in a neglected case of anorectal malformation

Fecaloma in a neglected case of anorectal malformation

Nonclosure of rectourethral fistula during posterior sagittal anorectoplasty: Our experience

Aim:To study the effect of nonclosure of rectourethral (RU) fistula and to do a comparative analysis of the complications with and without nonclosure of RU fistula during posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM).Materials and Methods:A total of 68 cases of ARM were included in the study group, of which 34 cases were those in whom RU fistula was not closed (group A) during PSARP. Another 34 successive cases were included in study group B in whom the RU fistula was closed as is conventionally done by using interrupted sutures.Results:Comparatively, group A had none or minimum urological complications as compared to Group B.Conclusion:RU fistula closure is not mandatory during PSARP and nonclosure avoids urological complications. It especially avoids urethral complications, which are 100% preventable.

Congenital pouch colon and segmental dilatation of the colon: A report of two unusual cases

This report describes two unusual cases of anorectal malformation. The first had a type III congenital pouch colon with a colovesical fistula. In the other very similar case, segmental dilatation of the colon was present along with penoscrotal hypospadias and, distally, a length of normal colon ending in a rectourethral fistula. In both patients, the appendix was short, stubby and a Y-shaped duplication of the normal colon was present just proximal to the dilated segment of colon.

One-stage correction of intermediate imperforate anus in males: preliminary results

Background: This prospective study was designed to assess the safety, cost effectiveness, and advantages of performing posterior sagittal anorectoplasty without colostomy on males with intermediate imperforate anus.Method: Five consecutive males with intermediate imperforate anus were entered into the study. Chest and abdominal x-rays, skeletal surveys, renal ultrasound scans, and invertograms were done. Patients were resuscitated, and Pena’s posterior sagittal anorectoplasty (PSARP) done in prone positions. Two-ml syringe vents were inserted into the new anus for 10 days. Cephalosporin and metronidazole were given as peri-operative antibiotics.Results: All patients had intermediate anomalies. There were no other major associated congenital anomalies. Urethral catheter could not be inserted in one patient. One patient presented with septicaemia and jaundice. He was deemed too ill to withstand a major operation. These 2 patients therefore had diverting colostomies. There were no problems with posterior sagittal anorectoplasty in the other 3 patients. The father of one patient discharged him against medical advice on the 5th postoperative day. The mother had post-partum haemorrhage and they went for traditional treatment because they could not provide blood donors. The skin wound of 2 patients healed completely at removal of stitches. Both are having monthly dilatations 9months and 1 year post-operatively.Conclusion: This preliminary study shows that it is feasible for males with intermediate imperforate anus to have safe posterior sagittal anorectoplasty without colostomy. The advantages of one, instead of 3 major operations, are many, especially in developing countries. If this result can be reproduced in high anomalies colostomy may be unnecessary in many cases of anorectal malformations with a lot of benefits to these unfortunate children and their poor families.

Scenario of neonatal surgery in West Bengal with reference to cases of anorectal malformation

Pediatric Surgery, though a super specialty does not enjoy the glamour and importance like other specialities, though, dealing with the most delicate of mankind, the children. The reasons for this are manifold and the results of this, brutal. This is a retrospective study carried at the major institutes of West Bengal where departments of pediatric surgery exist. We have observed a gross discrepancy between the number of patients admitted for surgically correctable congenital malformations and the standard state/national frequency of these disorders. We focus on the plight of a child not able to reach the level III health care system with a pediatric surgical back up and analyze the pros and cons with constructive criticism of the existing system.

Scenario of neonatal surgery in West Bengal with refrence to cases of anorectal malformation

Scenario of neonatal surgery in West Bengal with refrence to cases of anorectal malformation

One-stage correction of intermediate imperforate anus in males

This prospective study was designed to assess the safety, cost-effectiveness, and advantages of performing posterior sagittal anorectoplasty (PSARP) without colostomy on males with intermediate imperforate anus in a developing country. Fifteen consecutive males with intermediate imperforate anus were entered into the study. Chest and abdominal x-rays, skeletal surveys, renal ultrasound scans, and invertograms were done. Patients were resuscitated and Pena's PSARP done in prone positions. A 2-ml syringe vent was inserted into the new anus for 10 days. Babies were nursed prone postoperatively. Cephalosporin and metronidazole were given as perioperative antibiotics. All patients had intermediate anomalies. There were no other major associated congenital anomalies. A urethral catheter could not be inserted in one patient, and one patient who presented with septicemia and jaundice was deemed too ill to withstand a major operation; these two patients therefore had diverting colostomies. There were no problems with PSARP in the other 13 patients. One patient's father discharged him against medical advice on the 5th postoperative day; the mother had had postpartum hemorrhage, so they opted for traditional treatment because they could not provide blood donors. The skin wounds of 10 patients healed completely with removal of stitches; two boys had superficial wound infection. Parents who lived far from the hospital were taught how to dilate the anus. Follow-up has ranged between 3 months and 2 years. This prospective study shows that it is feasible for males with intermediate imperforate anus to have safe PSARP without colostomy. The advantages of one instead of three major operations are many, especially in developing countries. If this result can be reproduced in cases of high anomalies, colostomy may be unnecessary in many cases of anorectal malformations, with many benefits to these children and their families.