Anorectal malformations

Anorectal malformations

In an anorectal malformation, there is usually no opening in boys, and the rectum ends either blindly (notably in aneuploi dies) or with a fistula to the bulbar urethra ( Figure 18.13a prostate or bladder neck. Occasionally , there is a rectoperineal fistula in a boy . In contrast, there is usually a rectovestibular ( Figure 18.13b ) or rectoperineal fistula in gir ls; meconium is passed and therefore, many are missed on cursory newborn examinations. In girls, the rectum may join a common channel with the vagina and urethra; this is referred to as a cloaca ( Figure 18.13c ). In boys, a divided proximal sigmoid colostomy allows feed ing. A contrast study is performed through the defunctioned end ( Figure 18.14 ). Repair of prostatic and bladder neck fistu lae may be approached with a combined laparoscopic and per ineal approach, wher eas prostatic and bulbar urethral fistulae can both be approached in a posterior sagittal anorectoplasty (PSARP). The stoma is closed at a third stage. Most perineal and some vestibular fistulae can be transposed into the muscle complex without a stoma.

(a) Figure 18.13 (a) Rectobulbar urethral /f_i stula in a boy. (b) /uni00A0 Rectovestibular /f_i stula in a girl. (c) Cloaca in a girl. B R

Figure 18.14 A rectourethral /f_i stula, visible on a contrast study per

formed via a sigmoid colostomy. The bladder is /f_i lled with contrast via the /f_i stula and the radio-opaque dot has been placed on the infant’s perineum over the normal site of the anus. B, bladder; R, rectum.

Anorectal malformations

In an anorectal malformation, there is usually no opening in boys, and the rectum ends either blindly (notably in aneuploi dies) or with a fistula to the bulbar urethra ( Figure 18.13a prostate or bladder neck. Occasionally , there is a rectoperineal fistula in a boy . In contrast, there is usually a rectovestibular ( Figure 18.13b ) or rectoperineal fistula in gir ls; meconium is passed and therefore, many are missed on cursory newborn examinations. In girls, the rectum may join a common channel with the vagina and urethra; this is referred to as a cloaca ( Figure 18.13c ). In boys, a divided proximal sigmoid colostomy allows feed ing. A contrast study is performed through the defunctioned end ( Figure 18.14 ). Repair of prostatic and bladder neck fistu lae may be approached with a combined laparoscopic and per ineal approach, wher eas prostatic and bulbar urethral fistulae can both be approached in a posterior sagittal anorectoplasty (PSARP). The stoma is closed at a third stage. Most perineal and some vestibular fistulae can be transposed into the muscle complex without a stoma.

(a) Figure 18.13 (a) Rectobulbar urethral /f_i stula in a boy. (b) /uni00A0 Rectovestibular /f_i stula in a girl. (c) Cloaca in a girl. B R

Figure 18.14 A rectourethral /f_i stula, visible on a contrast study per

formed via a sigmoid colostomy. The bladder is /f_i lled with contrast via the /f_i stula and the radio-opaque dot has been placed on the infant’s perineum over the normal site of the anus. B, bladder; R, rectum.

Anorectal malformations

In an anorectal malformation, there is usually no opening in boys, and the rectum ends either blindly (notably in aneuploi dies) or with a fistula to the bulbar urethra ( Figure 18.13a prostate or bladder neck. Occasionally , there is a rectoperineal fistula in a boy . In contrast, there is usually a rectovestibular ( Figure 18.13b ) or rectoperineal fistula in gir ls; meconium is passed and therefore, many are missed on cursory newborn examinations. In girls, the rectum may join a common channel with the vagina and urethra; this is referred to as a cloaca ( Figure 18.13c ). In boys, a divided proximal sigmoid colostomy allows feed ing. A contrast study is performed through the defunctioned end ( Figure 18.14 ). Repair of prostatic and bladder neck fistu lae may be approached with a combined laparoscopic and per ineal approach, wher eas prostatic and bulbar urethral fistulae can both be approached in a posterior sagittal anorectoplasty (PSARP). The stoma is closed at a third stage. Most perineal and some vestibular fistulae can be transposed into the muscle complex without a stoma.

(a) Figure 18.13 (a) Rectobulbar urethral /f_i stula in a boy. (b) /uni00A0 Rectovestibular /f_i stula in a girl. (c) Cloaca in a girl. B R

Figure 18.14 A rectourethral /f_i stula, visible on a contrast study per

formed via a sigmoid colostomy. The bladder is /f_i lled with contrast via the /f_i stula and the radio-opaque dot has been placed on the infant’s perineum over the normal site of the anus. B, bladder; R, rectum.