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.
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Loss of the rectal reservoir could lead to a worse problem of incontinence with a patient who now has diarrhea. The results of treatment are dramatically different, and so we do not group these two defects into the same category [ 7 ]. At the time of defecation, the voluntary muscle structures relax. Giving the enema after the mapformasi meal of the day allows a more efficient cleansing of the bowel by taking advantage of the gastrocolic reflex.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
It can be performed through a transperineal or infracoccygeal route. The only way to definitively determine the patient’s anorectal defect is to perform a distal colostogram, which of course requires the presence of a colostomy. The repair of persistent cloacas represents a serious technical challenge that should be performed in specialized centers by pediatric surgeons dedicated to the care of these complicated patients [ 22 ].
However, on careful review of the largest series of these patients, it became clear that those with the most benign defects and thus the least amount of perirectal dissection had the worst constipation.
Anorectal Malformations in Children: If the third opening is seen within the vestibule, it is a vestibular fistula. Nil Conflict of Interest: Toilet training should be attempted at age 3, and if unsuccessful, anorekyal bowel management program should be initiated.
Advances in the management of anorectal malformations. All patients must be evaluated at birth to rule out one of these defects, and the most valuable screening test is an abdominal and pelvic ultrasound. The pullthrough of the rectum is similar to other anorectal malformations. Voluntary sphincter muscles, anal canal sensation, and colonic motility.
A child with a normal bowel movement pattern is trainable, whereas a child with the second pattern will likely need a bowel management program. Author information Copyright and License information Disclaimer. Table 2 Detailed classification of anorectal malformations ARM.
The rectum and vagina share a common wall and the vagina and urinary tract likewise have a common wall. The voluntary mmalformasi are used to push the rectal contents back up into the rectosigmoid and to hold them if desired, until the appropriate time for evacuation.
There is a wide spectrum of presentation ranging from low anomalies with perineal fistula having simple management to high anomalies with complex management. Such patients have become categorized as instances of “rectovaginal fistula” and the true diagnosis of cloaca has become evident only many years later.
This x-ray on rare occasion may show the column of air in the distal rectum to be within 1 cm of the perineum, and if this is the case, the baby can be treated like those with a recto-perineal fistula, and a newborn perineal operation can be performed.
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. General condition, duration of presentation and number of openings in the vestibule decide the management. Most patients who undergo repair of an ARM suffer from variable degrees of fecal incontinence, depending upon the type of anomaly, associated anomalies and the effectiveness of corrective procedure.
In resistant cases, The Malone antigrade continence enema procedure using an Appendicectomy represents a useful alternative. If the baby growing well, the repair can be performed at 1—2 months of age. The precise gynecologic anatomy must be ascertained either during the main repair or during colostomy closure if a laparotomy was not required during the main repair.
History Imperforate anus has been a well-known condition since antiquity. The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies. While in a patient with a good prognosis, this may be overflow incontinence, it may also represent true fecal incontinence in cases of very high imperforate anus or poor muscles and an abnormal sacrum.
A rectourethral fistula can be treated without an abdominal approach, but a rectobladderneck fistula always requires the abdomen to be entered either with laparoscopy or laparotomy. 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.
The sacrum is the most frequently affected bony structure. Posterior sagittal anorectoplasty has become the standard of care for dealing with ARM.
Posterior sagittal approach for the correction of anorectal malformations. Once the diagnosis of the specific defect is established, the functional prognosis can be rapidly predicted, which is vital in order to avoid raising false expectations in the parents.