Imperforated anus presentation for .pptx

Imperforated anus

1. IMPERFORATED ANUS DR.NASHWAN TASHAN

2. It is due to imperfect fusion of the post- allantoic gut with the proctodaeum . Incidence is one in 4500 newborns

3. Wingspread classification

4. Nonsyndromic ARM with fistula Rectoperineal Rectourinary (with bladder neck, bulbar or prostatic urethra) in males Rectovestibular , rectovaginal , cloaca in females Nonsyndromic ARM without fistula imperforate anus Nonsyndromic complex fistula cloaca Syndromic ARM-associated with different syndromes

5. Features Newborn presents with inability to pass meconium Abdominal distension , features of intestinal obstruction Improper anal dimple Complaints of passing meconium per urethra . It can be associated with VACTERL anomaly

6. Most common ARM in boys is rectobulbar fistula with fistula beginning distal to puborectalis from distal rectum to bulbar urethra. Most common ARM in females is rectovestibular fistula

7. Investigations Wangenstein's invertogram : Usually done 6-12 hours after birth, so as to allow air to reach the rectal pouch. A metal coin is strapped at the presumed site of anus and X-ray is taken. Length between the rectal pouch and anal dimple marker is more than 2.5 cm in high anal fistula. In low fistula, rectal pouch is distal to the Stephen's line ( Pubococcygeal line). In intermediate, pouch is at the level of ischial spine In high fistula, rectal pouch is proximal to t he Stephen's line.

8. Murugassu's technique : Through visible anal dimple, meconium is aspirated by passing a needle into the rectal pouch in sitting propped up position. Water soluble iodine dye is injected. Lateral X-ray is taken to study the level through Stephen line US abdomen Evaluation of cardiac function MRI spine.

9. Treatment In low fistula , single stage reconstruction is done under GA with very good results. i . Anoplasty. ii . Anovestibuloplasty . iii . Anal dilatation. iv . Incision of anal membrane In high fistula , initial colostomy is done . Later definitive procedure , i.e. Pull through operation through puborectalis and anastomosis of rectal pouch to create the anal canal is done . Closure of colostomy is done later. Posterior sagittal anorectoplasty

10. Anoplasty

11. Thank you