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Anorectal malformation

R
rupalpatel81

This document discusses anorectal malformations, which are developmental deformities of the lower end of the alimentary tract that occur due to arrest in embryonic development. Anorectal malformations can be classified into three main groups based on whether there is a visible abnormal opening, invisible opening, or no opening. They can also be classified based on where the rectum terminates in relation to the levator ani muscle. Clinical manifestations include abnormal or no anal opening and absence of passing meconium. Diagnosis involves physical examination, imaging tests, and urine/stool examinations. Management involves reconstructive surgery such as rectal anoplasty or initial colostomy followed by definitive surgery later.

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ANORECTAL MALFORMATION
DEFINITION Anorectal malformations are developmental deformities of the lower end of the alimentary tract. i.e. anorectal canal.
CAUSES The Exact cause of these malformation is not known. Due to arrest in embryonic development of the anus, lower rectum and urogenital tract at the 8th week of embryonic life.
Anorectal malformation
Anorectal malformation
CLASSIFICATION A. ARMs can be done into three groups in the infants without a normal anus. 1. with visible abnormal opening of the bowel- a. Anal stenosis b. Ano-perineal fistula c. Ano vestibular fistula in female
2. With an invisible but manifested opening of the bowel- a. Rectovaginal fistula in female b. Rectourethral fistula in male c. Rectovesicular fistula. 3. No manifested opening of the bowel- a. Persistent anal membrane b. Rectal atresia.
Anorectal malformation
Anorectal malformation
Anorectal malformation
ANO PERINEAL FISTULA
RECTAL ATRESIA
Anorectal malformation
B. ARMs classified in to two groups on the basis of levator ani muscle, which is the main muscle of anal control- 1. Supra levator or high ano-rectal malformations: When rectum terminates above the levator ani muscle, which is found as rectal atresia and rectovaginal fistula. 2. Trans levator or low ano rectal malformations: When rectum terminates below the levator ani muscle. E.g. ano vestibular fistula.
Anorectal malformation
CLINICAL MANIFESTATION ARMs usually diagnosed after birth immediately or within the hour by care giver. The important presenting feature are abnormally formed or no anal opening and absence of meconium or presence of fistula with passage of stool through fistula. In female baby the fistula may present between rectum and vagina or perineum. In male baby the fistula is commonly found between rectum and urinary tract or perineum.
The specific feature for specific anomalies are as follow: Imperforate anal membrane- Infant fails to pass meconium. Greenish bulging membrane. Anal stenosis- The baby may pass ribbon like stool with difficulty as the anal opening is very small.
Anal agenesis- It presents with only anal dimple. Usually fistula found to the perineum or urethra in male and perineum and vulva in female.
Rectoperineal fistula- It is found as small orifice in the perineum, usually anterior to the center of the external sphincter In male baby it is found to the scrotum and in female to the vulva. Rectovaginal fistula- It present with a communication between rectum and vagina.
DIAGNOSIS: Physical examination USG for diagnose the rectal pouch. X ray Urine examination for fistula diagnosis Micturating cystourethrogram for urinary tractabnormalities.
Anorectal malformation
MANAGEMENT: The reconstructive surgery In low ARMs rectal anoplasty in male. In female perineal anoplasty In high ARMs, initial colostomy is done in the neonatal period (PSARP) at age of 10 to 12 months. Or infant is having 7 to 9 kg body weight.
Colostomy closure is done after 10 to 12 week of successful definitive surgery.
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Anorectal malformation

  • 2. DEFINITION Anorectal malformations are developmental deformities of the lower end of the alimentary tract. i.e. anorectal canal.
  • 3. CAUSES The Exact cause of these malformation is not known. Due to arrest in embryonic development of the anus, lower rectum and urogenital tract at the 8th week of embryonic life.
  • 6. CLASSIFICATION A. ARMs can be done into three groups in the infants without a normal anus. 1. with visible abnormal opening of the bowel- a. Anal stenosis b. Ano-perineal fistula c. Ano vestibular fistula in female
  • 7. 2. With an invisible but manifested opening of the bowel- a. Rectovaginal fistula in female b. Rectourethral fistula in male c. Rectovesicular fistula. 3. No manifested opening of the bowel- a. Persistent anal membrane b. Rectal atresia.
  • 14. B. ARMs classified in to two groups on the basis of levator ani muscle, which is the main muscle of anal control- 1. Supra levator or high ano-rectal malformations: When rectum terminates above the levator ani muscle, which is found as rectal atresia and rectovaginal fistula. 2. Trans levator or low ano rectal malformations: When rectum terminates below the levator ani muscle. E.g. ano vestibular fistula.
  • 16. CLINICAL MANIFESTATION ARMs usually diagnosed after birth immediately or within the hour by care giver. The important presenting feature are abnormally formed or no anal opening and absence of meconium or presence of fistula with passage of stool through fistula. In female baby the fistula may present between rectum and vagina or perineum. In male baby the fistula is commonly found between rectum and urinary tract or perineum.
  • 17. The specific feature for specific anomalies are as follow: Imperforate anal membrane- Infant fails to pass meconium. Greenish bulging membrane. Anal stenosis- The baby may pass ribbon like stool with difficulty as the anal opening is very small.
  • 18. Anal agenesis- It presents with only anal dimple. Usually fistula found to the perineum or urethra in male and perineum and vulva in female.
  • 19. Rectoperineal fistula- It is found as small orifice in the perineum, usually anterior to the center of the external sphincter In male baby it is found to the scrotum and in female to the vulva. Rectovaginal fistula- It present with a communication between rectum and vagina.
  • 20. DIAGNOSIS: Physical examination USG for diagnose the rectal pouch. X ray Urine examination for fistula diagnosis Micturating cystourethrogram for urinary tractabnormalities.
  • 22. MANAGEMENT: The reconstructive surgery In low ARMs rectal anoplasty in male. In female perineal anoplasty In high ARMs, initial colostomy is done in the neonatal period (PSARP) at age of 10 to 12 months. Or infant is having 7 to 9 kg body weight.
  • 23. Colostomy closure is done after 10 to 12 week of successful definitive surgery.