ABSTRACT
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