Malformasi Anorektal. ANGKA KEBERHASILAN POSTEROSAGITTAL ANORECTOPLASTY (PSARP) YANG DINILAI DARI SKOR KLOTZ PADA PASIEN MALFORMASI ANOREKTAL. Faktor Risiko yang Memengaruhi Luaran Klinis Malformasi Anorektal pada Neonatus di RSUD Dr. Zainoel Abidin, Banda Aceh. Article. Full-text available.
|Genre:||Health and Food|
|Published (Last):||19 January 2005|
|PDF File Size:||9.49 Mb|
|ePub File Size:||8.73 Mb|
|Price:||Free* [*Free Regsitration Required]|
Those patients with anorectal malformation treated sdalah techniques in which the most distal part of the bowel was resected behave clinically as individuals without a rectal reservoir. The surgical approach to repairing these defects changed dramatically in with the introduction of the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and anorekta, tract [ 1 – 6 ].
First; are there associated anomalies that threaten the baby’s life and should be dealt with right away?
The origin of the problem of constipation is unknown. We believe that an anatomic classification would have more clinical value. Antegrade enema procedures, whereby enema is introduced in a conduit via appendicocecostomy, has been devised to help the patient clean its bowel [ 3031 ].
The tethered spinal cord in patients with anorectal malformations. In the normal patient, the voluntary muscle structures are represented by the levators, muscle complex, and external sphincter. A crosstable lateral radiograph can help show the air column in the distal rectum in the small percentage of patients for whom clinical evidence does not delineate in 16—24 hours the likely anorectal anomaly.
Anterior sagittal approach, involving anterior perineal dissection from the base of the scrotum to the posterior part of the anodermis used by some surgeons, with the aim of preserving the internal anal sphincter [ 26 ]. It is performed with the patient positioned prone with the pelvis elevated; multiple fine silk sutures are places at the mucocutaneous junction of the bowel orifice for traction. The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function.
Constipation that is not aggressively treated, in combination with an ectatic distended colon, eventually leads to severe constipation, and a vicious cycle ensues, with worsening constipation leading to more rectosigmoid dilation, leading to worse constipation. Diagnostic methods The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies. If the patient’s defect is of the type pointing to a good prognosis such as vestibular fistula, perineal fistula, rectal atresia, rectourethral bulbar fistula, or imperforate anus without fistula, one should expect that that child will have voluntary bowel movements by the age of 3.
National Center for Biotechnology InformationU. Definitive repair of this anomaly in the newborn period should be reserved for surgeons with significant experience repairing these defects.
A foley catheter is placed in the mucous fistula and the 3 cc balloon is inflated and pulled back to occlude the stoma during contrast injection.
The prevalence of tethered spinal cord rises with increasing height and complexity of the anorectal anomaly. Spinal anomalies including a tethered spinal cord can occur [ 1112 ]. The anal canal is normal and externally the anus appear normal.
The main factor adalau provokes the emptying of the rectosigmoid is a massive involuntary peristaltic contraction helped sometimes by a Valsalva maneuver. Hydrosoluble contrast material is injected into the distal stoma to demonstrate the precise location of the distal rectum and its likely urinary communication. Plain radiographs of the sacrum in the anterior-posterior and lateral projections can demonstrate sacral anomalies such as a hemisacrum and sacral hemivertebrae. Clinical inspection of ahorektal buttocks is important.
Long-term outcomes of adalsh malformations. A rectourethral fistula can be treated without an abdominal approach, but a rectobladderneck fistula always requires the abdomen to be entered either with laparoscopy or laparotomy. When evaluating the results of malformsai treatment of anorectal defects, we feel that one cannot group patients according to the traditional nomenclature into “high,” “intermediate,” and “low” defects, as malformations classified in a same group can have different treatments and different prognoses.
For example, a one-year-old child who has undergone a pull-through for imperforate anus and has one to three bowel movements per day with no soiling in between has a great potential for future fecal continence.
OEIS Omphalocele, exstrophy, imperforate anus, and spinal defects. Anorectal Malformations in Children. Clinical presentation Classification Comparing the results of reported series has always been a problem with anorectal malformations because different surgeons use different terminology when referring to types of imperforate anus.
Published online Jul Factors such as the status anoreltal the spine, sacrum, and perineal musculature affect the counseling of the anorekgal. If the common channel is less than 3 cm, the posterior sagittal approach without an abdominal approach can be used to repair the defect.
Bowel management for fecal incontinence in patients with anorectal malformations. The only adalan to definitively determine the patient’s anorectal defect is to perform a distal colostogram, which of course requires the presence of a colostomy. Furthermore, patients may have other spinal anomalies besides tethered cord such as syringomyelia and myelomeningocele.
The length of this common channel can range from 1 to 10 cm.