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.
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Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Increased heritability of certain types of anorectal malformations. Open in a separate window. Voluntary muscles can be used only when the patient has the sensation that it is necessary to use them.
The presence of a megarectum prior to the pull-through does correlate with postoperative constipation. Except for cloacas, in most cases of female malformations, distal colostography aonrektal not necessary because the fistula is evident clinically. Is surgery necessary for asymptomatic tethered cord in anorectal malformation patients?
Malforkasi a normal individual, the rectosigmoid remains quiet for variable periods of time one to several daysdepending ada,ah specific defecation habits. Fecal and urinary incontinence can occur even with an excellent anatomic repair, due mainly to associated problems such as a poorly developed sacrum, deficient nerve supply, and spinal cord anomalies.
Voluntary muscle structures In the normal patient, the voluntary muscle structures are represented by the levators, anoorektal complex, and external sphincter. The other implication of missing the diagnosis of cloaca involves repairing only the rectal component of the anomaly, leaving the patient with a persistent urogenital sinus.
When these girls were examined, the little pouch of what used to be the rectum was found asalah into the vestibule, indicating that these patients were been born with a rectovestibular fistula. Imperforate anus has been a well-known condition since antiquity. Better imaging techniques, and a better knowledge of the anatomy and physiology of the pelvic structures at birth have refined diagnosis and initial management, and the analysis of large series of patients allows better prediction of associated anomalies and functional prognosis.
Dilatations are a vital part of the postoperative management to avoid a stricture at the anoplasty. Pena A, Levitt M.
Loss of the rectal reservoir could lead to a worse problem of incontinence with a addalah who now has diarrhea. 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.
This malformation represents a wide spectrum of defects by itself. Epidemiology Anorectal malformations are congenital anomalies that occur in approximately 1 in live births. The early management of a newborn infant born with an anorectal anomaly is crucial and two important questions must be answered during adalaj first 24 to 48 hours of life.
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 and genital tracts. Urinary continence Urinary incontinence occurs in male patients with anorectal malformations only when they have an extremely defective or absent sacrum, or when the basic principles of surgical repair are not followed and important nerves are damaged during the operation.
The most important clinical implication of this is that liquid stool or soft fecal material may not be felt by the patient as it does not distend the rectum. These features are externally visible and help diagnose a perineal fistula. This new technique, described by KE Georgeson et al. The program, although simplistic, is implemented by trial and error over a period of one week. Anorectal malformations ARM represent a spectrum of abnormalities ranging from mild anal anomalies to complex cloacal anorrktal.
Anterior sagittal approach, involving anterior perineal dissection from the base of the scrotum to the posterior part of the anodermmqlformasi used by some surgeons, with the aim of preserving the internal anal sphincter [ 26 ].
In cases when the rectum or the vagina are very high and an malformaei approach as well is needed, laparoscopy can be used in combination with the posterior sagittal approach.
To avoid this, the distal stoma must be made intentionally small, as it will be used only for irrigations and radiologic studies. If the common channel is less than 3 cm, the posterior sagittal approach without an abdominal approach can be used to repair the defect. National Center for Biotechnology InformationU. Orphanet J Rare Dis.
The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function. For these patients, an effective bowel management program, including enema and dietary restrictions has been devised to improve their quality of life. Occasionally constipation becomes so severe that patients develop chronic fecal impaction and constant soiling. With early diagnosis, management of associated anomalies and efficient meticulous surgical repair, patients have the best chance for a good functional outcome.
We have arbitrarily defined two groups of patients. Early decision-making The early management of a newborn infant born with an anorectal anomaly is crucial and two important questions must be answered during the first 24 to 48 hours of life. The proximal stoma is connected to the upper gastrointestinal tract and drains stool. If the air column is greater than 1 cm from the perineum, a colostomy is indicated.
First; are there associated anomalies that threaten the baby’s life and should be dealt with right away? In the case of persistent cloaca, a distended vagina hydrocolpos can be identified.
Thus, to achieve some degree of sensation and bowel control, the patient must have the capacity to form solid stool. The posterior sagittal approach is an ideal method of defining and repairing anorectal anomalies.
Failure to avoid constipation can result in megarectum and megasigmoid, and can lead to fecal impaction and overflow incontinence.
This is the best way to demonstrate a recto-urinary communication, and to determine the real height of the rectum.
Hydrosoluble contrast material is injected into the distal stoma to demonstrate the precise location of the distal rectum and its likely urinary communication. The anorectal defect of imperforate anus without fistula may also be demonstrated with this radiologic evaluation.
Published online Jul An abdominal ultrasound determines the presence of an obstructive uropathy as well as the presence of a hydrocolpos. History Imperforate anus has been a well-known condition since antiquity.