Outcome of excision of megarectum in children with anorectal malformation

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

“…Age, median (range) (6) Megarectum and neuropathy (4) Neuropathy (1) Caudal regression (1) Curarino triad (1) IND (1) EA and TEF (1) Down's syndrome (1) RAIR (16) Mann-Whitney U P \ 0.0001 P \ 0.006 P \ 0.001 Table 4 Comparison of anorectal manometry, anal endosonography and modified Wingfield scores between children with isolated anorectal anomaly group and those with associated megarectum and neuropathy intractable constipation and faecal incontinence, which were reported recently (17).…”

“…We used our scoring system based on function and integrity of the IAS on ARM and ES to evaluate the faecal continence outcome, which was reported recently [17]. The internal and external anal sphincters are anatomically and functionally discrete.…”

“…The presence of megarectum was determined by consistent evidence of distal evacuatory disorder refractory to treatment, or extreme megarectum on presentation by finding of a palpable or radiologically evident rectum extending to umbilicus or above [17]. The rectal volume and compliance was not always possible to assess on ARM because of absence of a RAIR due to deficient IAS in some children.…”

“…Clinical outcome with regard to faecal continence was assessed by using modified Wingfield score (MWS). The MWS included scores of 0 for normal function, 1 for constipation, 2 for intermittent soiling more than three episodes per week and 3 for continual soiling every day [2,17]. This is a simple scoring system, which can be applied over a wide range of age including the young children.…”

“…Neuropathy and megarectum are likely to impact adversely on the functional outcome even in the presence of a good sphincter [2,[17][18][19][20]. The indicators of neuropathy in the context of ARA are unclear, but we consider that neuropathy affecting the bladder is one of the best indicators because of similar embryological origin of hindgut and bladder [20,21].…”