imperforate anus

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ِِِAnomalies Anorectal

Imperforate Anus & Cloacal Malformation

Anorectal Malformation :

Occur in 1\4000 neonates, male > female , most common defect in boys is a rectourethral fistula, most common defect in girls is rectovestibular fistula

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Types of imperforate anus:

The upside – down X – ray has been the classical method for determining the distance from the blind rectal pouch to a marker placed on or within the anal dimple.
According to pubococcygeal line (p – c) [ extended from the mid point at the pubis anteriorly to the coccyx ].
• Low types.
• Inter mediate.
• High type.

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- Perineal ( cutaneaus ) fistula

- Recto urethral fistula
- Bulbar
BOYS -Prostatic
- Recto vesicle fistula
- Imperforate anus without fistula
- Rectal atresia

Another classification of anorectal anomalies

• No need for colostomy
• Colostomy requiredired
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- Perineal ( cutaneaus ) fistula

- Vestibular F
- Persistent cloaca
GIRLS -Imperforate anus without F.
- Rectal atresia

Another classification of anorectal anomalies

• No need for colostomy
• Colostomy requiredired
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Clinical features: examination of:-

Perineum
Look for presence of anus , its size & site
Look for presence of an anal dimple
If there is an impulse on crying at the site of the anus , it denotes a low a normal
In ectopic anus, there is a subcutaneous fistulous tract full of meconium .
Meconium at the tip of the penis denotes a fistula to the bladder or urethra .


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Abdomin

There may be evidence of intestinal obst.

General exam.

To exclude associated congenital Anomaly.

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Investigation:-

Plain abdominal X – ray in the inverted position (invertogram).
The distance between radio opaque mark & the distal gas shadow is
Measured
If the distance > 1cm ----- high anomaly
If the distance < 1cm ----- low anomaly

Urine is examined for the presence of meconium , if present this denote a fistulous communication
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Treatment:

• All ano rectal anomalies can be corrected by posterior sagittal
• Approach with or without laparotomy
Persistent cloaca
A defect in which rectum, vagina, urinary tract meet & fuse into a single common channal & absence of hymen, the length of common channel varies from 1 – 7 cm .

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