Malformasi Anorektal. Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary. Anorectal malformations (ARMs) are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging.

Author: Gobar Akinokasa
Country: Egypt
Language: English (Spanish)
Genre: Art
Published (Last): 3 July 2014
Pages: 35
PDF File Size: 5.70 Mb
ePub File Size: 5.99 Mb
ISBN: 438-4-62559-113-9
Downloads: 96226
Price: Free* [*Free Regsitration Required]
Uploader: Bralabar

In a normal individual, the rectosigmoid remains quiet for variable periods of time one to several daysdepending on specific defecation habits. The bladder neck in most patients is competent, and these patients that require catheterization remain dry in between.

Those with a “high” defect did not survive that treatment. Children with an ARM are at risk for gross motor function problems so the nutritional status and bowel management should be optimized individually to prevent stunting and comprehensive physical and mental development.

This is achieved aanorektal keeping the colon quiet in between enemas. We have arbitrarily malgormasi two groups of patients. This anomaly has an excellent prognosis and therefore complications that could affect future continence must be avoided. When performing the colostomy in the newborn, the distal bowel should be irrigated to remove all of the meconium.

Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek

Fecal continence in patients having undergone malfomasi sagittal anorectoplasty procedure for a malfoormasi anorectal malformation improves at adolescence, as constipation disappears.

Failure to avoid constipation can result in megarectum and megasigmoid, and can lead to fecal impaction and overflow incontinence. These patients’ incontinence is much harder to manage because they pass stool constantly. For many centuries, physicians, as well as individuals who practiced medicine, created an orifice in the perineum of children with imperforate anus.

The absence or abnormal location of the anus is generally apparent. Imperforate anus anorekta cloacal malformations. After the baby is born, an intravenous line is placed for fluids and antibiotics, and a nasogastric tube is inserted to keep the stomach decompressed to avoid the risk of vomiting and aspiration.

Most patients with an anorectal malformation suffer from a disturbance of this sophisticated bowel motility mechanism. Congenital imperforated rectum, recto-urethral and recto-vaginal fistulae.


Anorectal malformations

In resistant cases, The Malone antigrade continence enema procedure using an Appendicectomy represents a useful alternative. Perineal signs found in patients with low malformations include the presence of meconium at the perineum, a “bucket-handle” malformation a prominent skin tag located at the anal dimple below which an instrument can be passedand an anal membrane through which one can see meconium. Except for cloacas, in most xnorektal of female malformations, distal colostography is not necessary because the fistula is evident clinically.

The better continence may be attributed to the better development of cerebral fibers. Urinary tract infections are also avoided, 3 it is relatively easy to wash and clean the part of the colon distal to the colostomy, 4 distal colostograms are easy to perform, 5 the sigmoid loop is kept distal to the colostomy which provides enough length to reach the perineum during the malformais pull-through procedure, 6 the separated stomas prevent spillage of stool from proximal to distal bowel, anrektal avoids impacted distal stool and urinary tract infections, 7 there is a low incidence of prolapse with this technique.

Anorectal malformations

During the first 60 malflrmasi of the 20th century, surgeons performed a perineal operation without a colostomy for the so-called low malformations. These findings are associated with a high malformation and therefore a colostomy should be performed.

This prevents formation of a megasigmoid, which may be responsible for the future development of constipation. The prevalence of tethered spinal cord rises with increasing height and complexity of the anorectal anomaly.

Operative Management of Anomalies in Male. There appears to be a low rate of association in families, but some appear to have an autosomal dominant inheritance pattern with a high incidence, as much as 1 in Decision-making for female newborns The decisions involved in managing the female newborn are anoorektal complicated.

Infracoccygeal route can directly demonstrate the puborectalis as a hypoechoic U-shaped band. The bowel may traverse the levator and not lay anterior to it. With early diagnosis, management of associated anomalies and efficient anirektal surgical repair, patients have the best chance for a good functional outcome.

Also included in the “high” category in male patients were those with completely different defects requiring differing treatments and carrying a different prognosis e. This voluntary contraction occurs only in the minutes prior to defecation, and these muscles are used only occasionally during the rest of the day and night. Chromosome 7q39 has three important loci, which are implicated for development of ARM, these include genes: The cloaca itself represents a spectrum and certainly defies the classification “high”, “intermediate”, and “low”.


To standardize the methodology for evaluation of outcome of patients with ARM Krickenbeck group came with their classification. If the third opening is seen within the vestibule, it is a vestibular fistula. The laparoscopically-assisted anorectal approach consists in mobilizing and bringing the rectum through the pelvic floor sphincter muscles through a minimal posterior incision.

However, the results of this approach are difficult to compare with those of other methods because terminology and classification are not consistent [ 3233 ]. Such patients have become categorized as instances of “rectovaginal fistula” and the true diagnosis of cloaca has become evident only many years later.

Furthermore, an internal sphincter saving technique has been devised when performing the posterior sagittal approach. Perianal dissection towards the laparoscopic light source favours accurate placement of a trocar to pull the rectum through the external sphincter muscle complex.

Please review our mlformasi policy. There does not appear to be evidence that this operation will impact on the functional prognosis of a patient with anorectal malformation.

These can be totally or partially repaired during the main operation. Approximately, half of children with ARM have associated anomalies. Patients who have undergone abdominoperineal operations for imperforate anus that included resection of the rectum suffer from a tendency to have diarrhea due to a lack of a rectal reservoir.

Predictions of future problems such as amenorrhea in cases of atretic uteri, or hydrometrocolpos and retrograde menses can be made in the newborn period. A crosstable lateral radiograph can help show the air column in the distal rectum in the small percentage of patients for whom clinical evidence does not delineate in 16—24 hours the likely anorectal anomaly.