Malformasi Anorektal. Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary. Anorectal malformations (ARMs) are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging.
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Bowel movement pattern prior to potty-training may give an important clue as to the child’s potential for continence. Biofeedback therapy was reported to be a simple and safe method for treating children. Growth and development until 5years of age.
The origin of the problem of constipation is malformadi. During the first 60 years of malformai 20th century, surgeons performed a perineal operation without a colostomy for the so-called low malformations. Bowel function Most patients who undergo repair of an ARM suffer from variable degrees of fecal incontinence, depending upon the type of anomaly, associated anomalies and the effectiveness of corrective procedure.
These patients’ incontinence is much harder to manage because they pass stool constantly. The functional results of the repair of anorectal anomalies seem to have significantly improved since the advent of the posterior sagittal approach.
It consists of enemas, colonic amorektal, or daily suppositories to keep the rectum vacant. Fecal continence depends on three main factors: The injection is continued until the child voids, and pictures are taken during micturition in order to show, in a single picture, the sacrum, height of the rectum, perineum, fistula location, bladder, vesicoureteral reflux if present, and urethra.
Posterior sagittal approach for the correction of anorectal malformations.
This assertion is supported by the authors’ experience of cloaca reoperations where it has been found that most patients who were originally operated on by a surgeon who classified the defect as a “rectovaginal fistula” had only the rectal component of the cloaca repaired and had been left with a persistent urogenital sinus. In these cases, medical management consisting of enemas plus a constipating diet, and medications to slow down the colonic motility is indicated. 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 anlrektal 26 ].
When performing the colostomy in the newborn, the distal bowel should be irrigated to remove all of anorekyal meconium. Untethering of the cord anorekttal indicated in the neurosurgical literature to avoid motor and sensory problems. It is the repair of the vagina, the urethra, and the associated urologic defects that represents the main surgical challenge.
Anorectal malformations ARMs are among the more frequent congenital anomalies encountered in pediatric surgery, with an estimated incidence ranging between 1 in and 1 in live births.
There has been marked improvement in survival of such patient over the last century.
The safest option for a surgeon without extensive experience in anorectal anomalies when faced with a baby with clinical evidence of a rectovestibular fistula is to perform a diverting colostomy. Other common problems in females are vaginal and uterine septation anomalies and vaginal agenesis. Furthermore, an internal sphincter saving technique has been devised when performing the posterior sagittal approach.
The repair of persistent cloacas represents a serious technical challenge that should be performed in mzlformasi centers by pediatric surgeons dedicated to the care of these complicated patients [ 22 ].
Defects range from the very minor and easily treated with an excellent functional prognosis, to those that are complex, difficult to manage, are often associated with other anomalies, and have a poor functional prognosis.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Am J Hum Genet. Table 2 Detailed classification of anorectal malformations ARM. Consequently, the traditional classification of “high”, “intermediate”, and “low” defects renders the results dubious. Computer tomography CT and magnetic resonance imaging MRI of pelvis have been utilized for the direct visualization of the sphincteric muscles. Most cases with low ARM have good bowel function and enjoy social activities.
Episodes of soiling are usually related to constipation, and when constipation is treated anorekta, the soiling frequently disappears. Urinary function The patients with ARM are frequently complicated with urinary tract anomalies or sacral anomalies. If the air column is greater than 1 cm malformaasi the perineum, a colostomy is indicated.
Ratto C, Doglietto GB, editor. Male newborn Male anorsktal with rectoperineal fistula do not need a colostomy. The patient feels the peristaltic contraction of the rectosigmoid that occurs prior to defecation. Voluntary sphincter muscles, anal canal sensation, and colonic motility.
The etiology of such malformations remains unclear and is anorekta, multifactorial. And second, should the infant undergo a primary procedure and no protective colostomy or a protective colostomy and a definitive repair at a later date? This applies for a select group of patients with enormous daily laxative requirements to keep their colons clean.
Single stage versus staged procedure There has been debate over single stage versus staged repair of ARM. Patients with real incontinence require a bowel management program, which involves cleaning of the child’s colon once a day by the use of a suppository, an enema or a colonic irrigation [ 29 ].
Levitt MA, Pena A. National Center for Biotechnology InformationU.
Concerning bowel and urinary function, patients with anorectal malformations and tethered cord have a worse functional prognosis but they also have higher anorectal defects, less developed sacrums, associated spinal problems, and less developed perineal musculature.
Depending on the amount of colon resected, the patient may have loose stools.