Anorectal malformation in children

Abstract

The lecture presents modern information about embryogenesis, associated anomalies, diagnosis, and treatment of various forms of anorectal malformations (ARM) in children. During the initial examination of ARM children the authors recommend the following sequence of actions for a neonatologist and a surgeon: catheterization the esophagus in order to exclude combined esophageal atresia; survey radiography of the abdominal organs in direct or lateral projections to exclude concomitant duodenal atresia, dilated intestinal loops and primary assessment of the condition of the spine and sacrum; echocardiography to detect concomitant heart and large vessel defects (occur in 30% of ARM newborns), Ultrasound of the kidneys and bladder. A special X-ray study to determine the location of the intestine al atresia is carried out by a pediatric surgeon no earlier than 18-24 hours after birth in newborns without an anus on the perineum. It is believed that after this period of time, the gas will fill the atresized part of the intestine, which is determined on the side image at the level of the coccyx or sacrum or in the abdominal cavity, depending on the type of pathology. To determine the prognosis of the functional state of the pelvic organs before surgery, it is recommended to determine the sacral index, since a visual assessment of the state of the sacrum and coccyx (counting the number of vertebrae) in most cases does not allow a quantitative assessment of the detected changes. The bowel management program provides training for the patient’s parent or child on how to empty the bowel in order to achieve a “clean” period (without constipation and fecal smearing) during the day. The schedule is developed individually for each patient, usually within one week. The issues of postoperative rehabilitation of patients at the stage of treatment in the clinic are discussed.