High pressure colostogram in anorectal malformations: Imaging spectrum of fistulas and beyond

Congress:

ECR 2020

Poster Number:

C-14677

Type:

Educational Exhibit

Keywords:

Paediatric, Anatomy, Gastrointestinal tract, Genital / Reproductive system male, Conventional radiography, Fluoroscopy, Diagnostic procedure, Congenital, Fistula, Not applicable

Authors:

S. Dash¹, S. Gupta², P. jain³, A. Mishra⁴; ¹NewDelhi/IN, ²New Delhi/IN, ³Delhi, Delhi/IN, ⁴new delhi, New Delhi/IN

DOI:

10.26044/ecr2020/C-14677

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-14677

Fig. 1: Embryological basis of ARM

Fig. 2: Location of Fistulas in Male ARM

Fig. 3: Location of Fistulas in female ARM

Table 1: Management decision making in ARM in early neonatal period

Learning objectives

To understand the anatomy and embryology of anorectal malformations and their classification To describe the usefulness of high pressure colostogram study in the evaluation of anorectal malformations

Background

Anorectal malformations are a group of complex congenital anomalies involving distal gastro-intestinal tract (i.e. distal rectum and anus) as well as urogenital system. It has a reported incidence of 1 in 5000 live births worldwide.[1,2] The presentations are extremely variable and the management thus can be very challenging. They can have multiple other associated anomalies in cardiovascular, genitourinary, gastrointestinal systems or in the spinal cord and vertebral column. EMBRYOLOGICAL BASIS: Most of the anorectal malformations result due to abnormal development of urorectal septum. DEVELOPMENT OF...

Findings and procedure details

High pressure distal colostogram is the most effective imaging technique for determining the anatomy of distal rectal pouch and fistula. MRI has been an useful alternative for identification of fistula with excellent understanding of pelvic floor anatomy. High pressure colostogram is stilThey usually are managed by diversion colostomy in early neonatal period followed by final repair with both abdominal and perineal combined approach. LOW ARM: They consist of anal stenosis, imperforate anus without fistula, rectoperineal or rectovestibular fistula. They usually are managed primary perineal repair.l...

Conclusion

Anorectal malformations are congenital anomalies with complex anatomy and embryology. Most of the cases have fistulous communication between gastrointestinal tract with Genito urinary tract or perineum. Understanding the detailed anatomy in each case is empirical for proper surgical planning. High pressure colostogram being a cheap and effective modality for demonstration of fistula, radiologists should be familiar with this technique for accurate diagnosis and management decision making.

Personal information and conflict of interest

A. Mishra; new delhi, NEW DELHI/IN - nothing to disclose S. Dash; NewDelhi/IN - nothing to disclose S. Gupta; New Delhi/IN - nothing to disclose P. Jain; Delhi, DELHI/IN - nothing to disclose

References

Levitt MA, Peña A. Outcomes from the correction of anorectal malformations. Curr Opin Pediatr 2005;17(3):394–401. Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis 2007;2:33. Holschneider A, Hutson J, Peña A, et al. Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 2005;40(10): 1521–1526. Gross GW, Wolfson PJ, Pena A. Augmented-pressure colostogram in imperforate anus with fistula. Pediatr Radiol. 1991;21:560–562.