Role of sonography in diagnosis of anorectal malformations

Anorecral malformations comprise a spectrum of diseases; some of these defects are minor and easily treated with an excellent functional prognosis. Others are complex and difficult to manage, their functional prognosis is poor, and frequently, they are associated with other defects. The management of a newborn infant with an anorectal malformation is critical, because it will determine the immediate future of the child [Pen A, 1992]. The aim is to evaluate the various modalities of diagnosis of congenital malformation; both clinical and radiological modalities [invertography, lateral prone cross-table radiography, perineal ultrasonography]. Our prospective study consists of 47 children with anorectal malformation admitted to the Pediatric Surgery Unit. Department of General Surgery. Assiut University Hospital from April 2004 to February 2005. They were subjected to clinical evaluation in the form of history consanguinity, pregnancy, date of presentation color of urine and suggestive of other congenital anomalies. General examination [general condition; body weight, vital signs, systemic examination; head and neck.; chest and heart, spine and extremities, nervous system, genitalia]. Strict perineal examination, meticulous perineal inspection for any fistulous opening probing of the fistula, looking for meconium coming from the urethra. And lastly, radiological evaluation, in the form invertogram, cross-table lateral prone radiogram and ultrasonography of the distal rectal pouch were done. Our study included 47 cases with anorectal malformation, 25 males and 21 females, their ages ranged form 1-day to 5 years. Associated anomalies beside the anorectal anomaly were found in 18 babies. All cases were submitted to clinical evaluation, and the type of defect was obvious in 31 cases [66%]. the remaining 16 cases [43%] need radiological evaluation to detect the type of anomaly. Clinical methods were more sensitive in the diagnosis of females, 18 of 21 female [85%] were diagnosed clinically three females need radiological study [15%]. From 26 males, 13 cases were diagnosed clinically [50%] and 13 cases need radiological evaluations to detect type of the anomaly. Imperforate anus is a common congenital anomaly that requires rapid evaluation and possible early surgical decompression. Appropriate surgical intervention depends upon the position of the distal rectal pouch and -its relation to puborectalis. radiological evaluations are needed to diagnose the level of the anomaly, and ultrasound of the rectal pouch was the most accurate method in the diagnosis of such anomaly

Outcome of multiple stages endorectal pull-through [soave-boley operation] for hirschsprung's disease

Thirty patients with Hirschsprung's disease were selected for this study. Multiple stage endorectal pull-through was performed for all cases. The complications were analyzed into three phases. Seventeen cases passed smoothly without complications, while thirteen cases developed complications. The complication rate decreased as the time passes. They were thirteen cases during the early phase, nine of them continued to suffer from complications during the intermediate phase, while only seven cases still suffering from some complications during the late phase. Patient satisfaction was encountered in 90% and 10% were unsatisfied [suffering from stool soiling]. Recurrent symptoms of Hirschsprung's disease were not found. Soave-Boley operation has many advantages and has no significant major complications with an acceptable outcome for most of the patients treated for Hirschsprung's disease

Pattern and prognostic risk factors in cases of neonatal intestinal obstruction

This study included 104 cases of neonatal intestinal obstruction [NIO]. The most common causes of NIO in this study were anorectal malformations [53.8%], followed by malrotations [12.5%] and congenital megacuitolon [63.7%]. The most presenting symptoms were abdominal distention [91.3%], failure to pass meconium [81.7%]and bilious vomiting [6.4%]. Associated congenital anomalies affecting other systems of the body were found in [33.6%]. The result revealed that the major risk factor in any neonate with intestinal obstruction is the delay in diagnosis and delay in operative intervention. Prematurity, microsomia and associated other congenital anomalies did appear to play a significant role in the outcome of the newborn with intestinal obstruction. The overall mortality was high among the above risky groups

One stage endorectal pull-through operation for Hirschsprung's disease, is it a safe and effective procedure or not?

Twenty patients out of sixty suffering from Hirschsprung's disease "H.D." were selected for this study, and admitted at Assiut U.H. and Sohag U.H. from the period of Jan. 93 to Jan. 1996. The criteria which directed our attention to perform pull-through as one stage without colostomy were [1] Lack history of recent or recurrent attacks of enterocolitis. [2] The patient was not severely ill at the time of diagnosis. [3] The patient had reasonable body weight [more than 75% of the expected average body weight]. [4] Presence of mild abdominal distention. [5] The child was not presenting with complete obstruction. [6] No gross dilatation of the colon as demonstrated by barium enema. [7] Co-operative parents. Original Soave's operation without preliminary colostomy was performed. No mortality was recorded in this study. Complications are discussed. One stage endorectal pull-through operation is a safe and satisfactory procedure for management of "H.D." in selected cases. It is free from significant or major complications, avoids the risk of multiple operations and successive exposures to anaesthesia. It is a cost and time saving operation for patient and hospital and gives the patient a chance to return to normal life in a short time

Intestinal obstruction in neonates: risk factors and prognosis

One hundred and four newborns presenting with symptoms of intestinal obstruction admitted to the Neonatal Intensive Care Unit in Assiut University Hospital were included in this study. Diagnosis was based on clinical examination including PR and traditional diagnostic studies as plain x-ray films of the abdomen supplemented by either an upper or lower gastrointestinal contrast study. Invertogram was needed in cases of anorectal malformations and pre and postoperative management was done in the NICU. The results revealed that lack of prenatal diagnosis, delay of postnatal presentation and /or delay in diagnosis and in surgical intervention were considered to be the major preoperative causes of the high mortality in neonates suffering from intestinal obstruction in the studied locality

Ultrashort Hirschsprung's disease: surgical study in upper Egypt

Twenty-four children suffering from chronic constipation were admitted to Surgery Department, Assiut University Hospital, and supposed to have ultrashort Hirschsprung's disease. The criteria for diagnosis of the disease was chronic constipation since birth or early childhood with or without soiling, dilated rectum on barium enema which was loaded with stool, absence of ganglion cells on rectal biopsy and clinical improvement after anorectal myomectomy. 18 cases fulfilled these criteria, the remaining 6 cases were proved to be usual type Hirschsprung 's disease. The disease represent about 1/6 of all cases of congenital megacolon treated surgically at the same period. It was rare in the females. Anorectal myomectomy is a simple, safe, easy procedure, without major complications, and not interfering with subsequent pull through operation if needed. It is curative for properly selected cases of ultrashort Hirschsprung's disease