Anomalies Anorectal

Question 1

Anomalies Anorectal

Answer 1

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

Question 2

Low type problem

Answer 2

Stenosis

Question 3

High type problem

Answer 3

incontinence

Question 4

Types of imperforate anus

Answer 4

1. Low types.
2. Inter mediate.
3. High type.

Question 5

Clinical features: examination of:-

Answer 5

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 .

Abdomin
There may be evidence of intestinal obst.

General exam.
To exclude associated congenital Anomaly.

Question 6

Investigation

Answer 6

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

Question 7

Treatment

Answer 7

1. All ano rectal anomalies can be corrected by posterior sagittal
2. Approach with or without laparotomy

Question 8

Persistent cloaca

Answer 8

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 .