Malformation, anorectal

The Wingspread classification divides anorectal malformations into high, intermediate or low form (Stephens and Smith 1988). The classification is based on the level of the rectal pouch relative to the levator ani muscle, i.e. above the levator ani is designated a supralevator or high, at the level of the... 

Anorectal malformations are frequently associated with other congenital anomalies, especially of... 

Table6.1. Suggested guidelines (Nievelstein et al. 1998b) for MR protocol for neonates and infants with anorectal malformations (based on a 1-T or 1.5-T magnet using ahead coil for neonates and a phased arraybody coil for older children). Axial and coronal planes should be angled to be parallel and perpendicular to the pelvic floor. Imaging of the spinal cord and kidneys is only necessary if associated anomalies are suspected...

Nievelstein RA, van der Werff JF, Verbeek FJ et al (1998a) Normal and abnormal embryonic development of the anorectum in human embryos. Teratology 57 70-78 Nievelstein RAJ, Vos A, Valk J (1998b) MR imaging of anorectal malformations and associated anomalies. Eur Radiol 8 573-581... 

Partin JC, Hamill SK, Fischel JEet al (1992) Painful defecation and faecal soiling in children. Pediatrics 89 1007-1009 Pena A (1993) Management of anorectal malformations in the new-born period. World J Surg 17 385-392 Powell RW, Raffensperger JG (1982) Congenital colonic atresia. J Pediatr Surg 17 166... 

The most common urogenital sinus malformations a radiologist will come across are patients suffering from female hypospadias (simple urogenital sinus), intersexual conditions, and cloacal malformation (urogenital sinus associated with anorectal malformation) (Fig. 7.18). 

The term imperforate anus includes all kinds of anorectal malformations from covering of the anus by a thin skin membrane to high anorectal atresia - with or without a fistula, into the urethra or bladder - and to cloacal anomalies in females. It is well known that a high proportion of patients with imperforate anus have this maldevelopment in association with anomalies of one or several other... 

As mentioned above, there is agreement in the literature that anorectal malformations are highly... 

Table 8.1. Associated malformations in 75 patients with anorectal malformations...

Stephens and Smith (1971) and others have demonstrated that the incidence of additional anomalies is twice as high in the high and intermediate group of anorectal malformations (85%) as in the low group (46%). These findings have been confirmed by the analysis of our 75 patients with anorectal malformations, which has shown an incidence of 85% in the high and intermediate forms versus 61% in the low forms (Hollwarth and Menardi 1983) (Table 8.2). 

Although almost every known malformation has been reported in association with anorectal malformations, analysis of anatomical localization shows that organ systems within the lower part of the body, e.g., the urogenital tract, are significantly more affected than those in the upper part. Similarly, detailed studies of the associated skeletal malformations of our patients showed that vertebral... 

Structural as well as functional anomalies are reported commonly in babies with anorectal malformations. Therefore, a careful evaluation of the urogenital tract is essential in these cases. 

The entire spectrum of imaging investigations and functional studies is necessary to detect urogenital anomalies in anorectal malformations. 

The treatment of functional or anatomical urinary tract abnormalities in patients with anorectal malformations does not differ from the treatment of those with isolated malformations. 

Boemers TML, Bax KM A, Rovekamp MH, van Gool JD (1995) The effect of posterior sagittal anorectoplasty and its variants on lower urinary tract function in children with anorectal malformations. J Urol 153 191-193... 

Boemers TML, de Jong TPVM, van Gool JD, Bax KMA (1996a) Urologic problems in anorectal malformations. 1. Uro-dynamic findings and significance of sacral anomalies. J Pediatr Surg 31 407-410... 

Boemers TML, Beek FJA, Bax NMA (1999) Guidelines for urological screening and initial management of lower urinary tract dysfunction in children with anorectal malformations - the ARGUS protocol. BJU Int 83 662-671... 

Moore TC, Lawrence EA (1952) Congenital malformations of the rectum and anus associated anomalies encountered in a series of 120 cases. Surg Gynecol Obstet 95 281-284 Murphy F, Puri P,Hutson JM et al (2006) Incidence and frequency of different types, and classification of anorectal malformations. In Holschneider AM, Hutson JM (ed) Anorectal Malformation in Children. Springer, Heidelberg 163-184... 

Parrott TS (1985) Urologic implications of anorectal malformations. Urol Clin N Am 12 13-21 Pellerin D, Berlin P (1967) Genito-urinary malformations and vertebral anomalies in ano-rectal malformations. Z Kinderchir 4 375-383... 

Pena A (1988) Posterior sagittal anorectoplasty results in management of 332 cases of anorectal malformations. Paediatr Surg Int 3 94-104... 

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