Radiological Assessment of Anorectal Malformations; The Role of Transperineal and Infracoccgeal Sonography in Male Type Imperforate Anus
Iraqi Postgraduate Medical Journal,
2020, Volume 19, Issue 4, Pages 287-296
Anorectal malformation is a complex spectrum of anomalies. There are different types of anorectal malformation. The distinction can usually be made on the basis of clinical data regarding the presence or absence of a visible perineal opening or passage of meconium through the vagina or urethra.
To assess the validity of ultrasonography in detection of the exact anomaly in male type imperforate anus, in order to help plan the proper surgical approach.
PATIENTS AND METHODS:
A prospective study carried out between December 2017 and December 2018, at pediatric surgery department in Central Teaching Hospital in Baghdad, Iraq. Nineteen patients with imperforate anus were enrolled in this study (all were males), their age ranged between 1 day and 6 months. All patients were sent for trans-perineal ultrasound and infracoccgeal ultrasound, which were performed by using a high-resolution 11 MHz linear array transducer, in which the rectal pouch-perineal distance(P-P distance), presence or absence of recto-urinary fistula along with its précised location and the relation of the blind rectal-pouch to the pubo-rectalis muscle were obtained for a proper classification of the type of imperforate anus.US findings were compared to the operative findings which were the gold standard.
The rectal pouch-perineal distance(P-P) was identified using US in all patients with a mean (27.3211) mm and SD +- (14.78631) mm. The puborectalis muscle was identified as a hypoechoic U-shaped band in all patients along with its relation to the blind rectal-pouch. There is a statistically high significant relationship between the US and the operative findings regarding the presence and precise location of the internal fistula (P-value=0.0001).US findings showed a high sensitivity of 92.8%, specificity of 100% and accuracy of 94.7%.
US whether in (Transperineal Infracoccygeal) approach is highly accurate, it provides an excellent imaging modality with high sensitivity and specificity in the detection of the internal fistula. US measurements are independent of age.
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