Comparison of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study and conventional contrast radiographic colostography in children with anorectal malformation

Abstract

Background:In children with high and intermediate anorectal malformation, distal colostography is an important investigation done to determine the relationship between the position of the rectal pouch and the probable site of the neo-anus as well as the presence or absence of a fistula. Conventionally, this is done using contrast with fluoroscopy or still X-ray imaging. This, however, has the challenges of irradiation, availability and affordability, especially in developing countries. This study compared the accuracy of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study (SCDS) with conventional contrast distal colostography (CCDC) in the determination of the precise location of the distal rectal pouch and in detecting the presence and site of fistulous communication between the rectum and the urogenital tract was studied.Materials and Methods:Trans-perineal ultrasound-guided pressure augmented SCDS, CCDC and intra-operative measurements were done sequentially for qualified infants with anorectal malformation and colostomy. Pouch skin distance and presence or absence of recto urinary or genital fistula was measured prospectively in each case. Statistical significance was inferred at P-value of <0.01.Results:There were thirteen infants, 9 males and 4 females. The age at onset of investigation ranged from 2 to 12 months with a median value of 9 months. Using paired t-test at a confidence interval of 95%, the P value when SCDS values are compared with CCDC is 0.19; and 0.06 when SCDS was compared with intra-operative measurements. Hence, there is no statistical difference as P > 0.01. On its ability to detect presence or absence of a fistula: SCDS had a sensitivity of 50.0%, specificity of 100.0%, accuracy of 69.2%, negative predictive value of fistulas of 55.6% and a positive predictive value of fistulas of 100.0%.Conclusion:Ultrasound-guided pressure augmented SCDS can safely and reliably be used to assess the distal colonic anatomy and the presence of fistula in infants with Anorectal malformation who are on colostomy.

Inter- and Intraobserver Variation in the Assessment of Preoperative Colostograms in Male Anorectal Malformations: An ARM-Net Consortium Survey

“…Conversely, in developing countries with limited access to contrast studies, the trans-perineal ultrasound-guided colostogram with saline has been proposed as an alternative method. However, that is an even more operator-dependent procedure ( 21 , 22 ). Hosokawa et al also proposes the use of ultrasound in combination with a voiding cystourethrogram in male neonates undergoing primary repair without colostomy with the aim to detect and locate the fistula as precisely as possible ( 23 ), and recently, the importance of the preoperative colostogram has been published ( 9 – 11 ).…”

Rectal Perforation following High-Pressure Distal Colostogram

“…1 Although different imaging techniques such as perineal ultrasound, pelvic magnetic resonance imaging (MRI), and voiding cystourethrogram have been described, the high-pressure distal colostogram is still considered the most important, valuable, and accurate diagnostic test to determine the position of the rectum and the presence of a fistula in patients with ARMs. [3][4][5][6][7] To perform an adequate study, a radiopaque marker (Barium paste or ball bearing) is positioned on the anal dimple, and a size 8 Foley catheter is introduced in the mucous fistula for approximately 5 cm before the catheter balloon is inflated with 2 to 3 mL of air or water. Traction is then applied on the catheter so that the balloon serves as a plug, preventing contrast leak.…”

Accuracy Of Transperineal Sonography And Distal Loopogram In Determining Distal Rectal Pouch-Perineal Distance And Fistula On Anorectal Malformation Post Colostomy Patients At Dr. Mohammad Hoesin Palembang

“…However, there are major drawbacks to using ionizing contrast under fluoroscopy or still using X-ray imaging. [1][2][3][4][5][6][7] Takahiro et al in 2016 stated that the sonographic diagnostic accuracy of low-type imperforate anus based on pouch-perineal distance and fistula location was better than cross-table Complex genitourinary anomalies that can replace pouches can also be quickly recognized.…”

“…One alternative radiological examination that can be used for faster initial management is sonographic examination. 1,7 Takahiro et al in 2016 stated that the sonographic diagnostic accuracy of low-type imperforate anus based on pouch-perineal distance and fistula location was better than cross-table radiographs. If the pouch-perineal distance on the cross-table radiograph is greater than 10 mm, sonographic examination to determine the location of the fistula may be recommended.…”

“…Using a t-test confidence interval of 95%, the P value when compared with the distal loopogram was 0.19 and the ultrasound with intraoperative was 0.06. Ability to detect the presence / absence of fistulas; USG has a sensitivity of 50%, a specificity of 100%, an accuracy of 69.2%, a negative predictive value of 55.6% and a positive predictive value of 100% 7.…”