Anorectal malformations in children

The prevalence of anorectal malformations

Anorectal deficiencies are observed in relation to 1:10 000 normal births. In 97% of children with these deficiencies, concomitant anomalies of other organs and systems are observed.

Rectal embryogenesis

The rectum, covered with a mucous membrane, develops with the endoderm of the primary intestinal tube, and its perineal part comes from the ectodermal funnel. They are separated by a cesspool, which perforates at 6-8 weeks of embryo development. Delayed perforation gives the bulk of congenital malformations of the rectum. The ectodermal funnel is combined not with the lower end – the apex, but with the front wall of the rectum. The end section of the embryo has a pronounced tail process, the thickness of which is deeper, more caudal than the anus, of the final intestine. This department was called the postanal gut. As the fetus develops, the caudal appendage atrophies, and the postanal intestine also decreases. The rectal cesspool of the vertical cloacal membrane drops in the frontal plane from top to bottom and is divided into two sections – the anterior urogenital ( sinus urogenitalis ) and the posterior rectal ( sinus anorectalis ). The membrane of the cesspool consists of two ectodermal plates – urogenital and rectal, with mesoblast tissue embedded between them . From the distal part of the membrane, the middle part of the perineum develops after the cloacal membrane lowers and separates the rectum from the urogenital region. In the mesoblast of the membranes of the cloaca, the sexual rudiments, consisting of male embryos from the Wolf channels, and in female embryos from the Mueller channels, pass. From these genital embryos, the internal and external male and female genital organs develop. In parallel with the development of the pelvic organs, the perineum is also formed. It is formed from two folds, rising on both sides of the cloaca.

Classification of anorectal malformations

Classifying anorectal malformations is quite difficult, and therefore there are numerous classifications of these shortcomings. In our practical work, we adhere to the classification of anorectal malformations after A. Penn. According to her, anorectal malformations in boys and girls are distinguished separately.

Anorectal malformations in boys:

Anal- skin fistula.
Anal stenosis
Anal membrane. In these defects, a colostomy is not indicated. Rectourethral fistula: • Bulbar. • Prostatic. Rectovesical fistula. Anorectal agenesis without fistula. Atresia direct kishki.Pri data vices shown overlay kolostomy.Anorektalnye defects in girls: Anal -kozhny (crotch) svisch.Pri this vice colostomy not shown. Vestibular fistula, vaginal fistula, anorectal agenesis without fistula, atresia of the rectum, persistent cesspool – with these malformations, a colostomy is indicated .

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