Management of Imperforate Anus
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.
KeywordsAnorectal malformations Imperforate anus Cloaca Recto-urethral fistula Perineal fistula Flat perineum Posterior sagittal anorectoplasty Anoplasty Posterior sagittal anorectovaginourethroplasty Hydrocolpos
- 2.Peña A, Hong AR. In: Mattei P, editor. Anorectal malformation. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar