ABSTRACT
OBJECTIVE@#To investigate the morbidity of congenital heart defects(CHDs) in children with anorectal malformation, and to summarize appropriate treatment.@*METHODS@#The clinical data and echocardiographic findings of 155 children with congenital anorectal malformations from the Third Affiliated Hospital of Zhengzhou University during January 2016 and October 2019 were reviewed. According to the surgical findings of anorectal malformations, the patients were categorized as the high/intermediate group and the low group; the CHDs were classified as minor CHDs and major CHDs. Multiple logistic regression was used to analyze the correlation of wingspread classification, and extracardiac malformations with the severity of CHDs.@*RESULTS@#Out of 155 children with anorectal malformations, 47 (30.3%) had different types of cardiac structural malformations, including 18 cases of minor CHDs (11.6%) and 29 cases of major CHDs (18.7%). Sixty children (38.7%) had extracardiac malformations, of which 38 cases (24.5%) had a single extracardiac malformation, 15 cases (9.7%) had multiple extracardiac malformations, 6 had trisomy 21 syndrome, and 1 had VATER syndrome. Multivariate logistic regression analysis showed that wingspread classification of anorectal malformation and extracardiac disorders were independent risk factors for major CHDs. The probability of major CHDs in children with high/intermediate anorectal malformation was 4.709 times higher than that with low anorectal malformation (@*CONCLUSIONS@#The morbidity of major CHDs is higher in severe cases with high/intermediate anorectal malformation and acute cases without fistula or with obstructed fistula and cases with multiple congenital disorders. Echocardiography can define the type and severity of CHDs, which are useful to develop the optimal diagnosis and treatment plan for children with anorectal malformation.
Subject(s)
Child , Humans , Abnormalities, Multiple , Anorectal Malformations/therapy , Heart Defects, Congenital/mortality , Retrospective StudiesABSTRACT
ABSTRACT Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy.
RESUMO A estritura ou estenose anal, embora incomum, é problema incapacitante. Essa condição afeta a qualidade de vida por causa da dor, do sangramento e da dificuldade de defecação, de incontinência ou aumento da frequência. A estenose anal ocorre quando o anoderma, normalmente flexível, foi substituído por tecido conjuntivo fibrótico, e o resultado é um canal anal anormalmente estenosado e inelástico. Na maioria dos casos, a estenose anal ocorre secundariamente a trauma, por causa iatrogênica, por doença inflamatória, radiação ou neoplasia. Em geral, se considera que o tratamento dessa condição é tarefa difícil, tendo sido sugeridos diversos métodos de tratamento. Com frequência a estenose anal não responde ao tratamento clínico conservador. Procedimentos cirúrgicos como as dilatações ou a anoplastia estão associados a complicações significativas, implicando difícil desafio terapêutico. Atualmente, o cirurgião conta com várias opções terapêuticas satisfatórias. No presente caso, relatamos e exploramos um novo tratamento clínico para estenoses anais, por meio da esfincterotomia a laser nos quatro quadrantes.
Subject(s)
Humans , Male , Middle Aged , Laser Therapy/methods , Anorectal Malformations/therapy , Sphincterotomy/instrumentation , Anal Canal/abnormalitiesABSTRACT
Pesquisa clinico-epidemiológica e terapêutica de pacientes portadores de anomalias anorretais AARsubmetidos a tratamento cirúrgico na Santa Casa de Misericórdia do Pará, período de janeiro de 2004 a dezembrode 2005. Método: estudo transversal de prontuários de 69 crianças, buscando-se dados como: tipo de anomalia,presença de malformações associadas, primeiro tratamento realizado e idade no momento destes. Posteriormente,20 pacientes foram entrevistados, sendo verificado se estes possuíam capacidade de expressar desejo de evacuar(Voluntary bowel movements); se apresentavam continência total, parcial (soiling) ou incontinência. Por último, foiverificado se apresentavam ou não constipação. Resultados: a maior frequência de fístula retovaginal em 43,5%das meninas; 43,3% dos meninos foi identificada, mais comumente, fístula retouretral; 50,7% dos pacientesapresentavam malformações associadas sendo as digestivas as mais comuns. Quanto ao resultado do tratamentocirúrgico, vimos que 80% das crianças apresentavam ?voluntary bowel movements?, sendo que 40% apresentavamcontinência total, 40% continência parcial e 20% incontinência e 45% dos pacientes apresentaram constipação.Considerações finais: cerca da metade das crianças apresentava anomalias associadas, sendo importante ainvestigação diagnóstica complementar em todos os pacientes. Os resultados do tratamento cirúrgico foramcompatíveis com a literatura internacional, demonstrando que as crianças vêm sendo tratadas, satisfatoriamente, noHospital da FSCMPA.
Evaluate epidemiologically and clinically the children with anorectal malformation that were subjectedto surgery in the Santa Casa de Misericórdia do Pará, from January 2004 until December 2005, also evaluating theresults of this treatment. Methods: information regarding the type of malformation, presence of associatedanomalies and the first surgical treatment were collected from the charts of the 69 patients subjected to surgery.Subsequently, 20 patients were interviewed about voluntary bowel movements (being able to express the wish todefecate), if they presented complete fecal continence, partial fecal continence (soiling) or total incontinence.Constipation was also evaluated. Results: the most prevalent type of ARM in girls was rectovaginal fistula(43,5%). In boys the most prevalent was rectourethral fistula (43,3%). Associated malformations were seen in50,7% of the children, affecting the digestive system mostly. Voluntary bowel movements were present in 80% ofthe patients. Complete fecal continence was found in 40%, partial continence in 40% and complete incontinence in20%. Constipation was seen in 45%. Final comments: half of the patients had associated anomalies which justifiesthe use of image diagnosis in the screening of all children. The results of the surgical treatment was compatiblewith international numbers showing that the children are receiving adequate treatment in this institution.