Imperforate Anus & Cloacal Malformation Pediatric surgery جامعة بغداد كلية الطب   ِِِAnomalies Anorectal Imperforate Anus & Cloacal Malformation Anorectal Malformation : Occur in 1\4000 neonates, male > female , most common defect in boys is a rectourethral fistula, most common defect in girls is rectovestibular fistula  

Types of imperforate anus: Pediatric surgery جامعة بغداد كلية الطب Types of imperforate anus: The upside – down X – ray has been the classical method for determining the distance from the blind rectal pouch to a marker placed on or within the anal dimple. According to pubococcygeal line (p – c) [ extended from the mid point at the pubis anteriorly to the coccyx ]. Low types. Inter mediate. High type.      

Another classification of anorectal anomalies Colostomy requiredired Pediatric surgery جامعة بغداد كلية الطب Another classification of anorectal anomalies   No need for colostomy - Perineal ( cutaneaus ) fistula - Recto urethral fistula - Bulbar BOYS -Prostatic - Recto vesicle fistula - Imperforate anus without fistula - Rectal atresia Colostomy requiredired

Another classification of anorectal anomalies Colostomy requiredired Pediatric surgery جامعة بغداد كلية الطب Another classification of anorectal anomalies   - Perineal ( cutaneaus ) fistula - Vestibular F - Persistent cloaca GIRLS -Imperforate anus without F. - Rectal atresia No need for colostomy Colostomy requiredired

Clinical features: examination of:- Perineum Pediatric surgery د.حسن كريم كاطع جامعة بغداد كلية الطب   Clinical features: examination of:- Perineum Look for presence of anus , its size & site Look for presence of an anal dimple If there is an impulse on crying at the site of the anus , it denotes a low a normal In ectopic anus, there is a subcutaneous fistulous tract full of meconium . Meconium at the tip of the penis denotes a fistula to the bladder or urethra .  

Abdomin General exam. Pediatric surgery جامعة بغداد كلية الطب     Abdomin There may be evidence of intestinal obst. General exam.   To exclude associated congenital Anomaly.

Pediatric surgery جامعة بغداد كلية الطب     Investigation:- Plain abdominal X – ray in the inverted position (invertogram). The distance between radio opaque mark & the distal gas shadow is Measured If the distance > 1cm ----- high anomaly If the distance < 1cm ----- low anomaly   Urine is examined for the presence of meconium , if present this denote a fistulous communication

Treatment: Persistent cloaca Pediatric surgery جامعة بغداد كلية الطب   Treatment: All ano rectal anomalies can be corrected by posterior sagittal Approach with or without laparotomy Persistent cloaca A defect in which rectum, vagina, urinary tract meet & fuse into a single common channal & absence of hymen, the length of common channel varies from 1 – 7 cm .    

Pediatric surgery د.حسن كريم كاطع جامعة بغداد كلية الطب