Unexpectedly deformed anal sphincter in low-type anorectal malformation.

Abstract:

PURPOSE:The sphincter muscles in anorectal anomalies, which do not appear in the surgical field, cannot be described adequately. Details of the anal sphincter in low-type anorectal malformations were investigated using 3-dimensional (3D) image analysis. PATIENTS AND METHODS:Thirty patients (10 males and 20 females) with low-type anorectal malformation were investigated with multidetector-row helical computed tomography. An image of the anorectal part was obtained with a slice thickness of 1 mm and a reconstruction pitch of 0.5 mm. A 3D reconstruction on a personal computer was made with a volume rendering method assisted by our own software (NewVES). RESULTS:Very thin vertical fibers (VFs) were observed behind the fistula in almost half of the low-type cases. They did not wrap the distal end of the fistula. The 3D images of these sphincters were different in each case. DISCUSSION:The fistula was dislocated forward from the deformed hypoplastic sphincter. We suggest that surgical mobilization of the anorectum into the center of the hypoplastic sphincter would be difficult using the cut back or Potts methods. CONCLUSION:The choice of surgical method should take into consideration the displaced and deformed hypoplastic anal sphincter.

journal_name

J Pediatr Surg

authors

Watanabe Y,Takasu H,Mori K

doi

10.1016/j.jpedsurg.2009.07.073

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

2375-9

issue

12

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(09)00638-1

journal_volume

44

pub_type

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