Abstract
Anorectal malformations, or imperforate anus, represent a wide range of congenital defects and are associated with other congenital anomalies, including cardiovascular, urologic, gastrointestinal, and musculoskeletal disorders. Appropriate work-up for associated anomalies should be performed prior to definitive management. After the diagnosis of an imperforate anus is made on newborn examination, evaluation for a fistula should be performed, and oftentimes the definitive anatomy is not known until after a fistulogram. In females with a single perineal opening or cloaca, the common length channel should be assessed using cystoscopy, vaginoscopy, and possibly magnetic resonance imaging (MRI). Hydrocolpos should be drained if found. In a patient without a fistula, an abdominal X-ray should be performed to evaluate the distance between the distal gas and the skin. In patients with more complicated anomalies, such as cloaca, recto-urethral fistulas and patients with rectal gas above the coccyx on abdominal X-ray, colostomy should be performed first and definitive repair delayed until further work-up can be performed. Otherwise, superficial fistulas may be managed with anoplasty and deeper fistulas managed with posterior sagittal anorectoplasty in males or posterior sagittal anorectovaginourethroplasty in females.
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Cho S, Moore SP, Fangman T. One hundred three consecutive patients with anorectal malformations and their associated anomalies. Arch Pediatr Adolesc Med. 2001;155(5):587. https://doi.org/10.1001/archpedi.155.5.587.
Peña A, Hong AR. In: Mattei P, editor. Anorectal malformation. Philadelphia: Lippincott Williams & Wilkins; 2003.
Tsuda T, Iwai N, Kimura O, Kubota Y, Ono S, Sasaki Y. Bowel function after surgery for anorectal malformations in patients with tethered spinal cord. Pediatr Surg Int. 2007;23(12):1171–4. https://doi.org/10.1007/s00383-007-2025-4.
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Abdulhai, S., Garrison, A. (2019). Management of Imperforate Anus. In: Docimo Jr., S., Pauli, E. (eds) Clinical Algorithms in General Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-98497-1_125
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DOI: https://doi.org/10.1007/978-3-319-98497-1_125
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