This group includes unusual options for anorectal deficiencies, each of which is a rather difficult task for the surgeon, and the treatment methods, like the prognosis, are extremely diverse. It is clear that with mixed anomalies there cannot be a single “recipe”. Each case requires individual podhoda.Pervichnaya diagnosis of anorectal malformations in girls and choice of lecheniya
Novorozhdenny with anorectal anomaly inspection of the perineum: Fistula is (92%):
- Cloaca (urgent assessment of the urinary system) – colostomy (at indications: vaginostomiya , urinary diversion) – conducting posterior sagittal anorectovaginourethroplasty .
- Vaginal or vestibular fistula – colostomy – posterior sagittal anorectoplasty .
- Skin (perineal) fistula – minimal posterior sagittal anorectoplasty in a newborn without a colostomy . No fistula (10%):
Carrying out an invertogram :
- If the diastasis is less than 1 cm – the minimum posterior sagittal anorectoplasty in a newborn without a colostomy .
- If diastasis is more than 1 cm – colostomy – after 4-8 weeks, exclude concomitant malformations, verify the normal development of the child, then conduct posterior sagittal anorectoplasty .
In girls, a review of the genitals provides more information about the nature of the defect than in boys. If when examining the genitals, only one hole is determined, then this indicates the presence of cloaca. In this case, it is urgent to conduct a urological examination to exclude concomitant defects. After this, a colostomy and / or vagiostasis is applied , as well as a cystostomy or some other variant of urine diversion. The main stage of surgical treatment of cloaca is called posterior sagittal anorectovaginos-urethroplasty and is usually performed after 6 months of age . Girls with anorectal problems of tumor formation in the lower abdomen are pathognomonic for hydrocolpos . In this case, it is necessary to drain the vagina by tubular vaginostomy , which allows the urethra to defecate freely in the bladder. Identification during examination of the perineum of a vaginal or vestibular fistula is an indication for colostomy . However, since these fistulas are often quite good enough to empty the intestines, there is no urgency in applying a colostomy in this situation. In such cases, the child can be discharged home, and if it grows and develops normally, then a colostomy is applied two weeks before the main operation.
If girls have a skin fistula, the tactics and prognosis are the same as for boys with this form of vice. Girls with an atresia of the anus, in which meconium does not leave within 16 hours after birth (from the genitals), should be examined radiologically ( invertogram ). Treatment is carried out according to the same principles as for boys with these types of anomalies. Urological examination of each child with an atresia of the anus should include ultrasound of the kidneys and the entire abdomen to exclude hydronephrosis or other deficiencies accompanied by impaired urine outflow. If abnormalities are detected during ultrasound, then a further in-depth urological examination is necessary.