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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Etiology Anorectal malformations ARM represent a spectrum of abnormalities ranging from mild anal anomalies to complex cloacal malformations.
After assessment of associated anomalies the child can be taken for a protective colostomy, followed by delayed repair later or a single staged definitive procedure can also be performed in selected cases. Anorectal malformations ARMs are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging between 1 in and 1 in live births.
Single stage procedure has less morbidity, mortality at low cost. These features are externally visible and help diagnose a perineal fistula.
The surgeon must be prepared to perform a urologic diversion if necessary. The posterior approach and direct visualization of the anatomy have allowed us to learn about important features. For patients with a common channel greater than three cm, a laparotomy is usually required. The enormously dilated rectosigmoid, with normal ganglion cells, behaves like a myopathic type of hypomotile colon.
To avoid this, the distal stoma must be made malformadi small, as it will be used only for irrigations and radiologic studies. The male babies with evidence of a recto-urinary tract communication should undergo fecal diversion with a colostomy. The cloaca itself represents a spectrum and certainly defies the classification “high”, “intermediate”, and “low”.
Depending on the amount of colon resected, the patient may have loose stools. Female newborn General condition, duration of presentation and number of malfformasi in the vestibule decide the management. They may have imperforate anus with no fistula. Voluntarily, the normal individual can relax the striated muscles which allow the rectal contents to migrate down into the highly sensitive area of the anal canal. Consequently, the traditional classification of “high”, “intermediate”, and “low” defects renders the results dubious.
The length of this common channel can range maalformasi 1 to 10 cm. A simultaneous abdominal and perineal approach in operations for imperforate anus with atresia of the rectum and rectosigmoid.
Clinical presentation Classification Comparing the results of reported series has always been a problem with anorectal malformations because different surgeons use different terminology when referring to types of imperforate anus. Adolescent females with low ARM are limited in terms of sociosexual aanorektal. Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation.
Infracoccygeal route can directly demonstrate the puborectalis as a hypoechoic U-shaped band. The etiology of such malformations remains unclear and is likely multifactorial. Laparoscopic repair malrormasi high imperforate anus.
For these patients, an effective bowel management program, including enema and dietary restrictions has been devised to improve their quality of life. The malformaasi anorectal approach consists in mobilizing and bringing the rectum through the pelvic floor sphincter muscles through a minimal posterior incision.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
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.
Laparoscopically-assisted anorectal repair can either be performed in the newborn period without a colostomy or in a stage-approach. Anorectal malformations ARM represent a spectrum of abnormalities ranging from mild anal anomalies to complex cloacal malformations.
Hydrosoluble contrast material is injected into the distal stoma to demonstrate the precise location of the distal rectum and its likely urinary communication. A hemisacrum is always associated with a presacral mass, which is commonly formed of dermoids, teratomas, or anterior meningoceles. As early as the s, it was recognized that there was an increased risk for a sibling of a patient with ARM to be born with a malformation, as much as 1 incompared with the incidence of about 1 in in the general population.
Bowel management for fecal incontinence in patients with anorectal malformations. Posterior sagittal approach for the correction of anorectal malformations. Those patients with anorectal malformation treated with techniques in which the most distal part of the bowel was resected behave clinically as individuals without a rectal reservoir.
Constipation appears to be a hypomotility disorder secondary to chronic bowel dilatation. Complications of posterior sagittal anorectoplasty. The fistula and lower part of the rectum are carefully dissected to permit mobilization of the rectum for backward placement within the limits of the sphincter complex. The surgeon must be prepared to open the bladder and to reimplant the ureters if necessary. These maneuvers are intended to prevent sepsis or metabolic acidosis [ 14 ]. Footnotes Source of Support: The surgical approach to repairing these defects changed dramatically in with the introduction anoorektal the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and genitourinary tract [ 1 – 6 ].
The anorrektal continence enema procedure: