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Alharbi R, Suchet-Dechaud A, Harzallah I, Touraine R, Ramond F. Expanding the clinical spectrum of Coffin-Siris syndrome with Anorectal Malformations: case report and review of the literature. Eur J Med Genet 2024:104948. [PMID: 38735569 DOI: 10.1016/j.ejmg.2024.104948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
Anorectal malformations (ARMs) represent a wide spectrum of congenital anomalies of the anus and rectum, of which more than half are syndromic. Their etiology is highly heterogeneous and still poorly understood. We report a 4-year-old girl who initially presented with an isolated ARM, and subsequently developed a global developmental delay as part of an ARID1B-related Coffin-Siris syndrome (CSS). A co-occurrence of ARMs and CSS in an individual by chance is unexpected since both diseases are very rare. A review of the literature enabled us to identify 10 other individuals with both CSS and ARMs. Among the ten individuals reported in this study, 8 had a variant in ARID1A, 2 in ARID1B, and 1 in SMARCA4. This more frequent than expected association between CSS and ARM indicates that some ARMs are most likely part of the CSS spectrum, especially for ARID1A-related CSS.
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Affiliation(s)
- Ralah Alharbi
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France; Department of Genetics, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Anna Suchet-Dechaud
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Inès Harzallah
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Renaud Touraine
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Francis Ramond
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
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Forero LT, Henderson R, Galarreta C, Swee S, Bird LM. Expansion of the core features of VACTERL association to include genital anomalies. Am J Med Genet A 2024:e63587. [PMID: 38687163 DOI: 10.1002/ajmg.a.63587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Genital anomalies have been reported with VACTERL association but not considered a core feature. Acute and chronic complications stemming from unrecognized genital anomalies have been reported in adolescents and young adults with VACTERL association. We sought to determine the frequency and severity of genital anomalies in VACTERL patients and identify which core features were more frequently associated with genital anomalies. A retrospective chart review from January 2010 to October 2021 identified 211 patients with two or more core VACTERL features, 34% of whom had a genital anomaly. The majority of genital anomalies (83% of those in males and 90% in females) were classified as functionally significant (requiring surgical intervention or causing functional impairment). The frequency of genital anomalies in the VACTERL cohort was higher if anorectal malformations or renal anomalies were present in both males and females and if vertebral anomalies were present in females. Due to their functional significance, genital anomalies should be assessed in all patients with two or more core features of VACTERL association, especially in those with anorectal or renal anomalies. Most genital anomalies in males will be detected on physical examination but additional investigation is often needed to detect genital anomalies in females. The timing and type of investigation are subjects for future study.
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Affiliation(s)
- Laura T Forero
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| | | | - Carolina Galarreta
- Department of Genetics and Metabolism, Valley Children's Hospital, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, California, USA
| | - Lynne M Bird
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
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3
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Zubar Zain A, Zuheir Fadil S, Naji H. Triplication of the Sigmoid: A Rare Incidental Finding in Association With an Anorectal Malformation During Colostomy Closure. Cureus 2024; 16:e54000. [PMID: 38476811 PMCID: PMC10928804 DOI: 10.7759/cureus.54000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
This case report presents a rare occurrence of triplication of the sigmoid, an unusual congenital anomaly, in a nine-month-old male with a known history of anorectal malformation. The patient, previously diagnosed with anal atresia and a rectourethral (prostatic) fistula, was admitted for the closure of his divided sigmoidostomy as the final step in correcting his anorectal malformation. Unexpectedly, during the release of the distal stoma, the presence of three distinct bowel lumens was discovered. To discern the native bowel, catheters were introduced into each lumen before proceeding with the excision of the triplicated sigmoid and subsequent stoma closure. This case underscores the complexity of diagnosing and managing unusual GI anomalies in the context of anorectal malformations, emphasizing the challenges encountered during surgical interventions.
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Affiliation(s)
- Ahmed Zubar Zain
- Pediatric Surgery, College of Medicine, Al-Nahrain University, Baghdad, IRQ
| | | | - Hussein Naji
- Pediatric Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
- Pediatric Surgery, Mediclinic Parkview Hospital, Dubai, ARE
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Adumah CC, Akpaette IC, Oni O, Obasi IA, Ogundele IO, Adesunkanmi A, Oyinloye OA, Talabi AO, Sowande OA, Adejuyigbe O. Penile Agenesis Associated with Anorectal Malformation and Bilateral Renal Agenesis: A Case Report and a Review of the Literature. Afr J Paediatr Surg 2024; 21:75-77. [PMID: 38259027 PMCID: PMC10903728 DOI: 10.4103/ajps.ajps_81_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2024] Open
Abstract
ABSTRACT Penile agenesis is complete absence of the penis in an otherwise normal phenotypic and genotypic male at birth that results from failure of development of the genital tubercle. It is an extremely rare anomaly that may be associated with anomalies in other organ systems, the extent and severity of which may affect the prognosis. The management is challenging and may have far reaching implications for the individual and family. While gender reassignment with bilateral orchidectomy and feminising genitoplasty has been carried out for most patients, significant psychosexual and social issues related to the male identity may occur due to foetal or postnatal sex steroid imprinting. We report a neonate with penile agenesis with bilateral renal agenesis and anorectal malformation.
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Affiliation(s)
- Collins Chijioke Adumah
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Iniofon Clement Akpaette
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Owolabi Oni
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | | | - Ibukunolu Olufemi Ogundele
- Paediatric Surgery Unit, Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Osun
| | - Abdulhafiz Adesunkanmi
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Oluwaseun Abioye Oyinloye
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Ademola Olusegun Talabi
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Oludayo Adedapo Sowande
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
| | - Olusanya Adejuyigbe
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex Ile Ife, Osun State, Osun
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Harada A, Tomita H, Tsukizaki A, Mizuno Y, Ishihama H, Shimotakahara A, Matsuoka K, Shimojima N, Hirobe S. Treatment Strategy for Currarino Syndrome Complicated With Anorectal Stenosis. Cureus 2023; 15:e50512. [PMID: 38226073 PMCID: PMC10788246 DOI: 10.7759/cureus.50512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
PURPOSE The present study aimed to review the treatment experience and outcomes of Currarino syndrome (CS) complicated with anorectal stenosis to evaluate the current treatment strategies. METHODS Seven cases of CS complicated with anorectal stenosis, treated at our hospital between 1998 and 2021, were retrospectively investigated. This is a case series article from a single institution. RESULTS In six and three cases and one case, the presacral mass was a mature teratoma, meningocele, and lipoma, respectively. Resection of the lesion was performed in all six cases of mature teratoma, and duraplasty was performed before resection in all three cases of meningocele. Moreover, surgery for anorectal stenosis was performed simultaneously in four patients. Surgery was performed for six cases of anorectal stenosis, with the remaining case relieved by dilation using a metal bougie. The surgical methods used were a partial resection with end-to-end anastomosis, anorectal strictureplasty, pull-through, posterior sagittal anorectoplasty, and cutback after mass resection. Pathological analysis of the anorectal stenoses revealed disorganized and rough smooth muscle fibers and the replacement of the stroma by an increased quantity of collagen fibers. CONCLUSIONS The clinical outcomes of CS can be improved by establishing a treatment flow chart and understanding the complicated pathophysiology of the disease.
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Affiliation(s)
- Atsushi Harada
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Hirofumi Tomita
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Ayano Tsukizaki
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Yuki Mizuno
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Hideo Ishihama
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | | | - Kentaro Matsuoka
- Pathology, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Naoki Shimojima
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Seiichi Hirobe
- Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
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Ye S, Feng W, Zhou Y, Ming A, Chen M, Yang C, Zheng C, Gao R, Diao M, Wang Y, Li L. Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty. Medicine (Baltimore) 2023; 102:e35825. [PMID: 37986398 PMCID: PMC10659725 DOI: 10.1097/md.0000000000035825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.
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Affiliation(s)
- Shiru Ye
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Wei Feng
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Anxiao Ming
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Minming Chen
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Changzhen Yang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Zheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Ruyue Gao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Wang
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
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Florou M, Kepertis C, Mouravas V, Anastasiadis K, Spyridakis I. Laparoscopic-Assisted Anorectoplasty for Anorectal Malformation With Recto-Prostatic Urethral Fistula: A Case Report and Review of the Literature. Cureus 2023; 15:e49008. [PMID: 38111460 PMCID: PMC10726792 DOI: 10.7759/cureus.49008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Congenital recto-urethral fistula is the most common form of anorectal malformation found in boys. The final repair includes the ligation of the fistula and the anorectoplasty, and can be achieved either way: posterior sagitally or laparoscopically. We present a case of a term male infant diagnosed with anorectal malformation and recto-prostatic urethral fistula, that underwent a laparoscopic-assisted posterior sagittal anorectoplasty in our department.
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Affiliation(s)
- Maria Florou
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | | | - Vassileios Mouravas
- Department of Pediatric Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
| | | | - Ioannis Spyridakis
- Department of Pediatric Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
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Hakalmaz AE, Tekant GT. Anorectal Malformations and Late-Term Problems. Turk Arch Pediatr 2023; 58:572-579. [PMID: 37584470 PMCID: PMC10724790 DOI: 10.5152/turkarchpediatr.2023.23090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/19/2023] [Indexed: 08/17/2023]
Abstract
Anorectal malformation is a disease with different subtypes and anatomical and functional multisystemic involvement that requires a unique approach in each age group. Anomalies associated with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association require detailed investigation and management. Beginning from the neonatal period, treatment is carried out with different surgical procedures. The clinical course of these patients may be associated with medical problems, accompanying congenital anomalies, perioperative management, or late sequelae. Constipation and fecal-urinary incontinence are the most common problems encountered in long-term follow-up. Renal failure is the most important cause of long-term mortality. In addition, these patients need to be under control until adulthood due to cardiological, spinal, genital, gynecological, and endocrine problems. In this follow-up, many pediatric disciplines such as neonatal intensive care, cardiology, nephrology, gastroenterology, and endocrinology cooperate with pediatric surgeons and pediatric urologists.
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Affiliation(s)
- Ali Ekber Hakalmaz
- Department of Pediatric Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Gonca Topuzlu Tekant
- Department of Pediatric Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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9
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Lee SJ, Cho SY, Yi W, Kang KP. Obstructive Uropathy Caused by Massive Fecal Impaction in a Patient With Congenital Anorectal Malformation and Neurogenic Bladder. Cureus 2023; 15:e47036. [PMID: 37965387 PMCID: PMC10642981 DOI: 10.7759/cureus.47036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Anorectal malformations (ARMs) comprise a broad spectrum of congenital anomalies involving both anorectal and urogenital tracts. After diagnosis, urological problems should be evaluated in addition to surgical correction of ARMs. Commonly encountered urological problems in patients with ARMs are recurrent urinary tract infections, vesicoureteral reflux, and chronic kidney disease. Therefore, the proper timing of urination and appropriate defecation habits are essential for preserving renal function in patients with ARMs. Here, we report a case of acute hydronephrosis by severe stool impaction in a patient with a history of congenital ARMs and neurogenic bladder. In this case, the physicians should consider properly managing chronic constipation and urination in patients with ARMs despite successful surgical corrections.
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Affiliation(s)
- Soo Jin Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Seok Young Cho
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Wonkyo Yi
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
| | - Kyung Pyo Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, KOR
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, KOR
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Amin MA, Manna RM, Nahin S, Hawlader MDH. Multidisciplinary strategies for managing acute watery diarrhea in children with congenital anorectal malformation and colostomy: A case study. Clin Case Rep 2023; 11:e8012. [PMID: 37808576 PMCID: PMC10551100 DOI: 10.1002/ccr3.8012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023] Open
Abstract
Congenital anorectal malformation (ARM) is a diverse group of anomalies affecting the development of the anal and rectal regions, with an estimated incidence of one in every 5000 live births. The colostomy is commonly performed as part of the staged management of children with ARM to prevent complications. However, the presence of acute watery diarrhea in children with ARM and colostomy poses significant management challenges due to the altered anatomy and physiology affecting stool regulation and absorption, exacerbated by various factors including infections, dietary issues, medication side effects, and underlying gastrointestinal complications.This case study explores the complexities involved in managing acute watery diarrhea in children with congenital ARM and colostomy. A comprehensive literature review was conducted to examine the existing evidence on the subject. The study highlights the multidisciplinary approach required, involving pediatricians, surgeons, and other specialists, to provide comprehensive care and support for these children. Effective management of acute watery diarrhea in children with congenital ARM and colostomy necessitates collaboration between pediatricians and surgeons. Pediatricians play a crucial role in assessing hydration status, monitoring electrolyte balance, and providing appropriate fluid and nutritional management. Surgeons address the surgical aspects of care and coordinate interventions with the management of acute diarrhea. The study underscores the importance of a multidisciplinary approach to deliver comprehensive care, optimize outcomes, and improve the quality of life for affected children. The management of acute watery diarrhea in children with congenital ARM and colostomy presents significant challenges due to the complex interplay of anatomical, physiological, and clinical factors. A multidisciplinary approach involving pediatricians, surgeons, and other specialists is vital for providing comprehensive care and support. This case study emphasizes the need for further research, guidelines, and collaborative efforts to enhance the management strategies for this vulnerable population.
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Affiliation(s)
- Mohammad Ashraful Amin
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Public Health Promotion and Development Society (PPDS)DhakaBangladesh
- Department of Clinical TrialsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ridwana Maher Manna
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Public Health Promotion and Development Society (PPDS)DhakaBangladesh
| | - Sabrina Nahin
- Department of PhysiologyGreen Life Medical College HospitalDhakaBangladesh
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11
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Morandi A, Maestri F, Ichino M, Pavesi MA, Macchini F, Di Cesare A, Leva E. Labeling male anorectal malformations: objective evaluation of radiologic imaging before surgery. Front Pediatr 2023; 11:1224620. [PMID: 37609362 PMCID: PMC10442156 DOI: 10.3389/fped.2023.1224620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose Prone cross-table lateral x-ray (CTLxR) and colostogram aid surgical planning for anorectal malformations (ARMs) without perineal fistulas. We suggest objective imaging tools to classify ARMs. Methods Three observers prospectively evaluated CTLxR and colostograms of male ARM patients (2012-2022) without perineal fistulas. The level of the rectal pouch was estimated with pubococcygeal (PC) and ischiatic (I) lines. On CTLxR, we described the "pigeon sign", defined as the rectal pouch ending with a beak-like image, suspicious for a rectourinary fistula. ARM was defined as rectobulbar when the rectal pouch was below the I line, rectoprostatic when between PC and I lines, and rectovesical when above the PC line. Concordance was assessed with Fleiss' kappa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the "pigeon sign" were calculated. Results Thirteen patients were included in this study. The interobserver agreement on CTLxR was 69.2% (k = 0.54) on pouch ending, 84.6% (k = 0.69) on the "pigeon sign", and 76.9% (k = 0.69) on diagnosis; concordance between observers and intraoperative diagnosis was 66.6% (k = 0.56). The "pigeon sign" had 75% sensitivity, 100% specificity, 100% PPV, and 50% NPV. The interobserver agreement on colostograms was 84.6% (k = 0.77) on pouch ending and 89.7% (k = 0.86) on diagnosis; concordance between observers and intraoperative diagnosis was 92.3% (k = 0.90). Conclusion PC and I lines and the "pigeon sign" are useful tools in examining CTLxR and colostograms. Adequate CTLxR interpretation may modify surgical strategy.
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Affiliation(s)
- A. Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Maestri
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. A. Pavesi
- Pediatric Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A. Di Cesare
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E. Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Fan J, Liu M, Lin Y, He Y, Fang Y. Anorectal malformation combined with Hirschsprung's disease: a case report. Front Pediatr 2023; 11:1182342. [PMID: 37292375 PMCID: PMC10244652 DOI: 10.3389/fped.2023.1182342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
Anorectal malformation (ARM) and Hirschsprungs disease (HSCR) are frequently associated with other congenital malformations, but rarely with one another. We describe the case of a child with intermediate anorectal malformation who underwent ARM correction. This child experienced recurrent postoperative symptoms, including intestinal obstruction, nutrition intolerance, and weight loss. The child was diagnosed with Hirschsprung's disease by colon barium contrast and pathological findings from a rectal biopsy, and subsequently underwent pull -through procedure after conservative treatment failed. After six months of postoperative follow-up, the patient still experiences occasional episodes of enteritis, but the symptoms are substantially less severe than they were before surgery, and the patient's weight is slowly increasing. We described a case of a child who had ARM combined with HSCR. Although the association between ARM and HSCR is uncommon, severe constipation or enteritis following complete correction of ARM in the absence of anal stricture should prompt consideration for HSCR. Before the second stage of ARM surgery, pay close attention to the barium enema examination, as an abnormal shape may indicate the presence of HSCR.
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13
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Bokova E, Svetanoff WJ, Lopez JJ, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations. Children (Basel) 2023; 10:children10050846. [PMID: 37238394 DOI: 10.3390/children10050846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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14
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Shojaeian R, Hiradfar M, Bahrami Taqanaki P, Ameri L, Parvizi Mashhadi M. Evaluating the utility of cystoscopy, distal colostography, and sonography for locating the fistula in patients with anorectal malformation: a case series. Ann Med Surg (Lond) 2023; 85:1436-1441. [PMID: 37229021 PMCID: PMC10205290 DOI: 10.1097/ms9.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
Anorectal malformations are congenital conditions ranging from a simple perianal fistula to a complex cloacal malformation. Since the precise determination of the location of the fistula is the central pillar in choosing the type of surgery, this study aims to evaluate and compare the efficacy of three techniques, transperineal ultrasound, distal colostography, and cystoscopy. Materials and methods This study was performed on patients with anorectal abnormalities who had undergone decompressive colostomy and were planned for anorectoplasty in the period from September 2017 to March 2019 in a pediatric surgical center. To answer our question, all three mentioned methods were conducted before the surgery and were compared with the intraoperative findings. Results Sonography, distal colostography, and the second cystoscopy findings were similar to intraoperative conclusions concerning the presence of a fistula in patients, whereas blind cystoscopy had 30% accuracy and similarity. Regarding the type of fistula sonography, distal colostography, and second cystoscopy each had 50, 37.5, and 10 inconsistency with the intraoperative findings. In all cases where a fistula was detected in blind cystoscopy, the location of the fistula was correctly determined by this modality. Data analysis on the pouch to perineum distance measurements obtained from sonography and colostography were significantly different from that of surgery. Conclusion The results of this study emphasize the need to perform several diagnostic modalities to determine the location and type of fistula to improve diagnostic accuracy.
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Affiliation(s)
- Reza Shojaeian
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
| | - Mehran Hiradfar
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
| | - Pegah Bahrami Taqanaki
- Mashhad University of Medical Sciences, Mashhad, Iran, University of Medical Sciences, Azadi Square
| | - Leila Ameri
- Parsian Imaging Center, Mashhad, Iran, Parsian Imaging Center, Mashhad, Khorasan Razavi, Iran
| | - Mahdi Parvizi Mashhadi
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
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15
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Kurashima M, Joshi S, Sobrino J, Blewett C. Rectal Atresia Treated Via a Transanal and Posterior Sagittal Approach: A Report of Two Cases. Cureus 2023; 15:e38694. [PMID: 37292545 PMCID: PMC10245193 DOI: 10.7759/cureus.38694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Rectal atresia is a rare cause of bowel obstruction in neonates with a normal-appearing anus. We present two different types of rectal atresia requiring different surgical management. Case one was a one-day-old term male with web-type rectal atresia diagnosed preoperatively with bedside obliteration of the web. Subsequent transanal web resection was performed. Case two was a one-day-old male born at 28 weeks weighing 980 g with significant cardiac defects including aortic atresia. The patient underwent initial colostomy creation and delayed rectal anastomosis via posterior sagittal anorectoplasty. We review the published literature, discuss the surgical strategy, and highlight the decision-making of diverting ostomy creation and approach of definitive anorectal anastomosis.
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Affiliation(s)
- Maho Kurashima
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Samrudhi Joshi
- Pediatric Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - Justin Sobrino
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Christopher Blewett
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
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16
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Pelizzo G, Canonica CPM, Destro F, Meroni M, Rizzo D, Canazza L, Selvaggio GGO, Durante E, Zuccotti G, Calcaterra V. Anorectal Malformations: Ideal Surgery Timing to Reduce Incontinence and Optimize QoL. Children (Basel) 2023; 10. [PMID: 36832533 DOI: 10.3390/children10020404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Anorectal malformations (ARMs) are rare and involve a wide spectrum of malformations. Prenatal diagnosis is often incomplete, and the diagnostic pathway is started during the newborn period to identify the type of malformation and the correct treatment. This retrospective study included patients between 8 and 18 y.o. diagnosed with ARM, referring to Our Clinic. We proposed two questionnaires, Rintala Bowel Function Score and the Fecal Incontinence Quality of Life Scale, and we defined four groups referring to surgical timing (age in months < 3, 3-6, 6-9, >9). In total, 74 patients were recruited (mean age 13.05 ± 2.80 y.o.), and data analysis showed a significant relationship between comorbidity and surgical timing. Moreover, timing was related to outcome in terms of fecal continence (better if surgery performed before 3 months) and Quality of Life (QoL). QoL, however, is influenced by other factors (emotional and social life, psychological sphere and take of care of chronic disease). We considered rehabilitation programs, more often practiced by children who underwent surgery after 9 months, to maintain an appropriate relational life. This study highlights the importance of surgical timing as the first step of a multidisciplinary follow-up, taking care of the child in every phase of his growth, tailored to the single patient.
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17
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Feng W, Mu H, Chen M, Zhu J, Xiang C, Fan L, Hou J, Die X, Wang Y. Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function. Front Pediatr 2023; 11:1124647. [PMID: 36911041 PMCID: PMC10003345 DOI: 10.3389/fped.2023.1124647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Background The need to search for ganglia in the terminal rectum/fistula of complex anorectal malformations (ARMs) remains controversial. This study aims to evaluate the relationship between ganglia absence in the terminal rectum/fistula and defecation function after anoplasty. Methods A retrospective review of patients who received anoplasty for treating male imperforate anus with rectobulbar (RB)/rectoprostatic (RP) fistulas at a tertiary pediatric hospital was conducted with registered demographic data, imaging study results, and information on the terminal rectum/fistula specimen (excision extension and pathological findings). According to the pathological findings, patients were divided into Groups 1 (ganglia absence) and 2 (ganglia presence). Furthermore, the postoperative defecation function was evaluated using various rating scale questionnaires. Statistical analysis was performed using SPSS 22.0. Results Of the 62 patients, 18 (29.0%) showed ganglia absence in the terminal rectum/fistula. By analyzing the imaging data, spinal anomalies and spinal cord anomalies were found in 30.6% (19/62) and 56.5% (35/62) of patients, respectively. Baseline information was comparable between Groups 1 and 2 (P > 0.05). For defecation function, there were no significant differences in Kelly scores between the two groups (4.0 ± 0.8 vs. 4.4 ± 1.1, P = 0.177), while Krickenbeck (3.7 ± 1.8 vs. 5.2 ± 1.4) and Rintala (13.7 ± 3.6 vs. 16.0 ± 2.7) scores in Group 1 were significantly lower than those in Group 2 (both P < 0.05). The overall incidence of constipation was 50% (31/62), being higher for Group 1 than Group 2 (77.5% vs. 38.6%, P = 0.002). The area under the curve of ganglia absence for predicting constipation was 0.696, with 77.8% sensitivity and 61.4% specificity. Conclusion Ganglia absence in the terminal rectum/fistula of male imperforate anus with RB/RP fistulas is associated with constipation after anoplasty, but it has limited predictive value for postoperative constipation. It is necessary to search for ganglia in the terminal rectum/fistula, both intraoperatively and postoperatively.
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Affiliation(s)
- Wei Feng
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Huaqi Mu
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Minmin Chen
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jin Zhu
- Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chenzhu Xiang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linxiao Fan
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jinping Hou
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaohong Die
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yi Wang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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18
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Huang H, Liu X, Li Z, Lin J, Yang H, Xu Z. Ectopic scrotum and penoscrotal transposition: Case report and literature review. Front Pediatr 2023; 11:1015384. [PMID: 36896407 PMCID: PMC9989158 DOI: 10.3389/fped.2023.1015384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background Ectopic scrotum (ES) is an extremely rare congenital scrotal malformation. Ectopic scrotum with VATER/VACTERL [vertebral defects (V), anal atresia or anorectal malformations (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), cardiac defects, renal malformations (R), and limb defects (L)] association is even rarer. There are no uniform guidelines for diagnosis and treatment. Clinical case We described a 2-year-5-month-old boy who has ectopic scrotum and penoscrotal transposition and reviewed relevant literature in this report. We performed laparoscopy exploration, rotation flap scrotoplasty, and orchiopexy and achieved a great result during the postoperative follow-up. Conclusions Combined with the previous literature, we made a summary to come up with a plan for the diagnosis and treatment of ectopic scrotum. Rotation flap scrotoplasty and orchiopexy are worthy of considering operative methods in treating ES. For penoscrotal transposition or VATER/VACTERL association, we can treat the diseases individually.
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Affiliation(s)
- Haoran Huang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Zuoqing Li
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junjie Lin
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Yang
- Department of Pediatric Surgery, Meizhou People's Hospital, Meizhou, China
| | - Zhe Xu
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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19
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Liu C, Wang S, Dai J, Li J, Wu X, Liu Y, Yao Z, Ma L, Sun X, Sun D. Effect of megarectum on postoperative defecation of female patients with congenital rectovestibular fistula or rectoperineal fistula. Front Pediatr 2023; 11:1095054. [PMID: 37051433 PMCID: PMC10084926 DOI: 10.3389/fped.2023.1095054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Background To assess the effect of megarectum on postoperative defecation of female patients with congenital rectovestibular fistula or rectoperineal fistula. Methods From March 2013 to February 2021, 74 female patients with congenital rectovestibular fistula or rectoperineal fistula were treated. The age of patients ranged from 3 months to 1 year. Barium enema and spinal cord MRI were performed in all children. 4 patients were removed from the study because of spinal cord and sacral agenesis. Finally, 70 patients underwent one-stage anterior sagittal anorectoplasty (ASARP). Anal endoscopy and anorectal pressure measurement were performed 1 year after surgery. All patients were divided into two groups depending on the presence of megarectum (+) and (-) and observed for constipation and anal sphincter function. Results 16 patients (4 months to 1 year) were complicated with megarectum, and 5 patients (3 months to 9 months) were without megarectum. The incision infection was seen in 3 patients. All patients were followed up for 1 year to 5 years. Fecal soiling was seen in 2 patients and constipation in 14 patients. Among 16 patients with megarectum, soiling was seen in 1 patient and the constipation in 12 patients. Among 54 patients without megarectum, soiling was seen in 1 patient and constipation in 2 patients. There was a significant difference in the incidence of postoperative constipation between the two groups (megarectum (+) 75% vs. megarectum (-) 3.7% (P < 0.05)). However, there was no significant difference in the score of anal sphincters between the two groups (P < 0.05). And there was no significant difference in anal resting pressure (P = 0.49) and length of anal high pressure area (P = 0.76). 7 patients with constipation and megarectum acquired normal anal function after the dilated rectum was resected. Conclusion Megarectum increases the possibility of difficult postoperative defecation in the patients with congenital rectovestibular fistula or rectoperineal fistula. However, constipation was not associated with ASARP postoperative effects on sphincter function. Resection of megarectum is helpful to the improvement of constipation.
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Affiliation(s)
- Chunxiang Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinyu Dai
- Department of Pediatric Surgery, Shanxi Children’s Hospital, Taiyuan, China
| | - Jian Li
- Department of Pediatric Surgery, Shanxi Children’s Hospital, Taiyuan, China
| | - Xiaoxia Wu
- Department of Pediatric Surgery, Shanxi Children’s Hospital, Taiyuan, China
| | - Yong Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhiwei Yao
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Lushun Ma
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaobing Sun
- Department of Pediatric Surgery, Shanxi Bethune Hospital, Taiyuan, China
- Correspondence: Xiaobing Sun Daqing Sun
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Correspondence: Xiaobing Sun Daqing Sun
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20
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Zhang Z, Cheng Y, Ju J, Shen W, Pan Z, Zhou Y. Analysis of the efficacy of biofeedback for faecal incontinence after surgery for anorectal malformation. Ann Med 2022; 54:2385-2390. [PMID: 36039487 PMCID: PMC9448432 DOI: 10.1080/07853890.2022.2114607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the therapeutic effects of biofeedback in the treatment of faecal incontinence (FI) after surgery for anorectal malformation (ARM). METHODS Clinical data were collected from paediatric patients for postoperative biofeedback due to FI caused by ARM between May 2017 and November 2021. The data included the duration of symptoms, the integrity of the anal sphincter, anorectal manometry parameters, and FI scores. These patients were divided into the low ARM group (group A) and the high ARM group (group B). RESULTS A total of 45 paediatric patients were enrolled in the study. There were 28 cases in group A and 17 cases in group B. The differences in age, gender, and body weight were not statistically significant between the two groups (p > 0.05). The differences in the clinical indicators were also not statistically significant between the two groups at the time of the initial evaluation. The duration of symptoms was 2.21 ± 0.71 years and 4.14 ± 1.89 years in groups A and B. There were 16 cases with an intact anal sphincter in group A and only two cases with an intact anal sphincter in group B. This difference was statistically significant between the two groups (p < .05). The anal resting pressure, initial sensitivity threshold, defaecation sensitivity threshold, defaecation urge threshold, and FI scores were significantly improved in both groups post-treatment compared to pre-treatment (p < .001). Strong impulses improved significantly in group A, while strong impulses did not improve significantly in group B. The multivariate logistic regression analysis with these variables further showed that symptom duration and anal sphincter integrity were the main factors influencing the therapeutic effects of biofeedback. CONCLUSION Biofeedback plays a positive role in the treatment of FI in paediatric patients following surgery for ARM. Symptom duration and anal sphincter integrity were found to be the main factors influencing the therapeutic effect of biofeedback.
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Affiliation(s)
- Zhenqiang Zhang
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Yuan Cheng
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Junjun Ju
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Weichen Shen
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Zhubin Pan
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
| | - Yuliang Zhou
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, China
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21
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Evans-Barns HME, Tien MY, Trajanovska M, Safe M, Hutson JM, Dinning PG, King SK. Post-operative colonic manometry in children with anorectal malformations: A systematic review. Neurogastroenterol Motil 2022; 34:e14415. [PMID: 35699343 PMCID: PMC10078517 DOI: 10.1111/nmo.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/07/2022] [Accepted: 04/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with anorectal malformations may experience constipation and fecal incontinence following repair. The contribution of altered anorectal function to these persistent symptoms is relatively intuitive; however, colonic motility in this cohort is less well understood. Manometry may be used to directly assess colonic motility. PURPOSE The purpose of this systematic review was to synthesize the available evidence regarding post-operative colonic motility in children with anorectal malformations and evaluate the reported equipment and protocols used to perform colonic manometry in this cohort. This systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We conducted a systematic review of four databases: Embase, MEDLINE, PubMed, and the Cochrane Library (1st January 1985-22nd July 2021). Studies reporting colonic manometry performed in children following anorectal malformation repair were assessed for eligibility. Data were extracted independently by two authors. Four studies were eligible for inclusion. Of the combined total cohort of 151 children, post-operative colonic manometry was conducted in 35. Insufficient reporting of medical characteristics, bowel function, and manometric outcomes restricted comparison between studies, and limited clinical applicability. No results from high-resolution colonic manometry were identified. Despite the prevalence of post-operative bowel dysfunction in children with repaired anorectal malformations, this systematic review highlighted the markedly limited evidence regarding post-operative colonic motility. This cohort may benefit from assessment with high-resolution techniques; however, future work must emphasize adherence to standardized manometry protocols, and include robust reporting of surgical characteristics, bowel function, and manometric outcomes.
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Affiliation(s)
- Hannah M E Evans-Barns
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Y Tien
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Misel Trajanovska
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Safe
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John M Hutson
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Phil G Dinning
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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22
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Jacobs SE, Tiusaba L, Bokova E, Al-Shamaileh T, Russell TL, Varda BK, Feng C, Badillo AT, Levitt MA. Where Is the Vagina? A Rectal Stricture after a Presumed Cloacal Repair Turns Out to be the Mobilized Vagina and a Missed High Rectovaginal Fistula. European J Pediatr Surg Rep 2022; 10:e145-e147. [PMID: 36225532 PMCID: PMC9550519 DOI: 10.1055/s-0042-1755538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022] Open
Abstract
We present a case of a rare complication in a 10-month-old female referred to our institution for an anal stricture after primary cloacal repair as an infant. Multimodal imaging, careful physical exam, and endoscopic evaluation revealed her vagina had been pulled through to the location of her anal sphincter muscle complex. We describe the correction of this problem, including identification of her rectum.
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Affiliation(s)
- Shimon E. Jacobs
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Tamador Al-Shamaileh
- Department of General Surgery, Division of Pediatric Surgery, King Hussain Cancer Center, Amman, Jordan
| | - Teresa L. Russell
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States,Address for correspondence Marc A. Levitt, MD Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National HospitalWashington, DC 20010United States
| | - Briony K. Varda
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Feng
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Andrea T. Badillo
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Marc A. Levitt
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
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23
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Jangid MK, Sharma J, Chanchlani R, Malik R, Ahmad R. Delayed complication due to retained contrast following augmented pressure distal loop colostogram in anorectal malformation. Afr J Paediatr Surg 2022; 19:265-267. [PMID: 36018212 PMCID: PMC9615961 DOI: 10.4103/ajps.ajps_107_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Augmented-pressure distal loop colostogram (APDC) is the most important diagnostic investigation to delineate the detailed anatomy to plan the reparative management of anorectal malformations. APDC is generally considered safe, with a very low complication rate. Herein, we present an unreported complication of APDC, manifesting as acute abdomen, due to retained contrast in distal loop. The patient was managed with evacuation of retained contrast from distal loop. We recommend evacuating the contrast from the distal loop following APDC.
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Affiliation(s)
- Mahendra Kumar Jangid
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jitendra Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajesh Malik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Reyaz Ahmad
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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24
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Pacio-Miguez M, Parrón-Pajares M, Gordon CT, Santos-Simarro F, Rodríguez Jiménez C, Mena R, Rueda Arenas I, F Montaño VE, Fernández M, Solís M, Del Pozo Á, Amiel J, García-Miñaur S, Palomares-Bralo M. Broadening the phenotypic spectrum of EVEN-PLUS syndrome through identification of HSPA9 pathogenic variants in the original EVE dysplasia family and two sibs with milder facial phenotype. Am J Med Genet A 2022; 188:2819-2824. [PMID: 35779070 DOI: 10.1002/ajmg.a.62883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 01/25/2023]
Abstract
EVEN-PLUS syndrome is a rare autosomal recessive disorder caused by biallelic pathogenic variants in the mitochondrial chaperone called mortalin, encoded by HSPA9. This genetic disorder, presenting with several overlapping features with CODAS syndrome, is characterized by the involvement of the Epiphyses, Vertebrae, Ears, and Nose (EVEN), PLUS associated findings. Only five individuals presenting with the EVEN-PLUS phenotype and biallelic variants in HSPA9 have been published. Here, we expand the phenotypic and molecular spectrum associated with this disorder, reporting two sibs with a milder phenotype and compound heterozygous pathogenic variants (a recurrent variant and a novel one). Also, we confirm a homozygous pathogenic variant in the family originally reported as EVE dysplasia.
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Affiliation(s)
- Marta Pacio-Miguez
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - Manuel Parrón-Pajares
- Servicio de Radiodiagnóstico. Hospital Universitario La Paz, Madrid, Spain.,Skeletal Dysplasia Multidisciplinary Unit (UMDE) and European Reference Network on Rare Bone Diseases ERN-BOND, Hospital Universitario La Paz, Madrid, Spain
| | - Christopher T Gordon
- INSERM U1163, Université de Paris, Institut Imagine, Paris, France.,Service de Génomique des Maladies Rares, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - Fernando Santos-Simarro
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Skeletal Dysplasia Multidisciplinary Unit (UMDE) and European Reference Network on Rare Bone Diseases ERN-BOND, Hospital Universitario La Paz, Madrid, Spain.,ITHACA-European Reference Network, Madrid, Spain
| | | | - Rocio Mena
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Inmaculada Rueda Arenas
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | | | - María Fernández
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Mario Solís
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Ángela Del Pozo
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - Jeanne Amiel
- INSERM U1163, Université de Paris, Institut Imagine, Paris, France.,Service de Génomique des Maladies Rares, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - Sixto García-Miñaur
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,ITHACA-European Reference Network, Madrid, Spain
| | - María Palomares-Bralo
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,ITHACA-European Reference Network, Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Spain
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25
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Sharifi-Rad L, Ladi-Seyedian SS, Ashjaei B. Management of post-surgical faecal incontinence due to anorectal malformations by pelvic floor rehabilitation. J Paediatr Child Health 2022; 58:1379-1383. [PMID: 35485438 DOI: 10.1111/jpc.15997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022]
Abstract
AIM Many patients with anorectal malformations (ARM) experience a long-lasting problem with faecal incontinence (FI). We assessed the effectiveness of a pelvic floor rehabilitation program including transcutaneous functional electrical stimulation (TFES) in combination with pelvic floor muscle (PFM) exercises on post-surgical FI in children with ARM. METHODS Data of 40 children at the age of 4 years or older who had undergone surgical correction for ARM and suffered from persistent FI referring for pelvic floor rehabilitation were analysed respectively. Patients underwent TFES and PFM exercises for 20 sessions. TFES was applied for 20-min during each session, two times a week. A paediatric FI score questionnaire and a bowel habit diary were completed both before and after the treatment for all children. We completed a FI quality of life questionnaire before the therapy and again after treatment for all patients. RESULTS Twenty-two out of 40 (55%) patients responded completely to the treatment (100% reduction in FI episodes) after the completion of treatment sessions, sustained in 19/40 (47.5%) patients after 6 months. Mean ± SD of FI score was 4.9 ± 3.6 at baseline that significantly reduced to 2.4 ± 1.3 and 2.4 ± 1.8 after completion of treatment sessions and 6 months later, respectively (P < 0.05). CONCLUSIONS Our results show that TFES and PFM exercises have a considerable beneficial impact on post-surgical FI in children with ARM.
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Affiliation(s)
- Lida Sharifi-Rad
- Department of Physical Therapy, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Pediatric Surgery, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ashjaei
- Department of Pediatric Surgery, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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26
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Thiem CE, Stegmann JD, Hilger AC, Waffenschmidt L, Bendixen C, Köllges R, Schmiedeke E, Schäfer FM, Lacher M, Kosch F, Grasshoff-Derr S, Kabs C, Neser J, Jenetzky E, Fazaal J, Schumacher J, Hoefele J, Ludwig KU, Reutter H. Re-sequencing of candidate genes FOXF1, HSPA6, HAAO, and KYNU in 522 individuals with VATER/VACTERL, VACTER/VACTERL-like association, and isolated anorectal malformation. Birth Defects Res 2022; 114:478-486. [PMID: 35362267 DOI: 10.1002/bdr2.2008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The acronym VATER/VACTERL association describes the combination of at least three component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb defects (L). Individuals presenting two CFs have been termed VATER/VACTERL-like. Recently, FOXF1, HSPA6, HAAO, KYNU, TRAP1, and ZIC3 have been proposed as candidate genes for VATER/VACTERL, VATER/VACTERL-like, and ARM. Re-sequencing studies identified disease-causing variants in TRAP1 and ZIC3, the contribution of other genes was not independently investigated. One affected variant carrier in FOXF1 was previously identified. Here we re-sequenced FOXF1, HSPA6, HAAO, and KYNU in 522 affected individuals. METHODS Using molecular inversion probe (MIP) technology, re-sequencing was performed in 63 individuals with VATER/VACTERL association, 313 with VATER/VACTERL-like association, and 146 with ARM. All individuals were of European ethnicity. Variant filtering considered variants with a minor allele frequency (MAF) ≤0.01 for putative recessive disease-genes HSPA6, HAAO, and KYNU. For the putative dominant disease-gene FOXF1 we considered variants with a MAF ≤0.0001. In silico prediction tools were used for further prioritization. RESULTS Only two variants in FOXF1 in two independently affected individuals [c.443G>T, p.(Cys148Phe); c.850T>C, p.(Tyr284His)] passed our filter criteria. One individual presented with ARM, the second presented with TE and C comprising atrial and ventricular septal defects. Sanger sequencing confirmed both variants but also their inheritance from the healthy mother. CONCLUSION Our analysis suggests that FOXF1, HSPA6, HAAO and KYNU do not play a major role in the formation of VACTER/VACTERL phenotypes or ARM.
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Affiliation(s)
- Corina E Thiem
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Jil D Stegmann
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Alina C Hilger
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Research Center On Rare Kidney Diseases (RECORD), University Hospital Erlangen, Erlangen, Germany
| | - Lea Waffenschmidt
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Charlotte Bendixen
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Department of General, Visceral, Vascular and Thoracic Surgery, Unit of Pediatric Surgery, University Hospital Bonn, Bonn, Germany
| | - Ricarda Köllges
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Eberhard Schmiedeke
- Clinic for Paediatric Surgery and Paediatric Urology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Ferdinand Kosch
- Department of Pediatric Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Sabine Grasshoff-Derr
- Pediatric Surgery Unit, Buergerhospital and Clementine Kinderhospital, Frankfurt, Germany
| | - Carmen Kabs
- Department of Paediatrics Surgery, Muenchen Klinik gGmbH, Munich Clinic Schwabing, Munich, Germany
| | - Jörg Neser
- Department of Pediatric Surgery, General Hospital, Chemnitz, Germany
| | - Ekkehart Jenetzky
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Julia Fazaal
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kerstin U Ludwig
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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27
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Kumar A, Bangar V, Khan NA, Patel JN, Gupta A, Yadav PS, Chadha R, Choudhury SR. Correlation of the Position of the Anal Dimple with the Caudal Termination of the Striated Muscle Complex in Patients with Anorectal Malformations. J Indian Assoc Pediatr Surg 2022; 27:185-190. [PMID: 35937128 PMCID: PMC9350651 DOI: 10.4103/jiaps.jiaps_362_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022] Open
Abstract
Background In children with anorectal malformations (ARM), the vertical fibres of the striated muscle complex (SMC) are believed to be located within the limits of the anal dimple (AD). Methods Forty five cases of ARM underwent posterior sagittal anorectoplasty (PSARP), median age 8.5 months. During PSARP the anterior, posterior limits and midpoint of the AD and SMC were marked. The location of AD was correlated with SMC. Results A 'well developed' AD and SMC was seen in 80 % and 86.7 % patients respectively. The mean width of the AD and SMC was more in females than in males (20.96 vs. 18.98 mm and 14.24mm vs. 13.45mm respectively). In 36 cases (80 %), across the spectrum of ARM, the SMC was posterior in relation to the AD. In 7 cases (15.5 %) it correlated in position with the AD and in 2 cases (4.44 %), it was anterior to the AD. Conclusions In the majority of cases AD and SMC were 'well developed' and the location of the SMC does not correlate with that of the AD. This has significant practical value in the important step of optimizing the placement of the rectum through the center of the SMC during repair.
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Affiliation(s)
- Amit Kumar
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Vipan Bangar
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Jigar N. Patel
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Amit Gupta
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Partap Singh Yadav
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India,Address for correspondence: Dr. Partap Singh Yadav, 127, Sector 21, Gurugram - 122 016, Haryana, India. E-mail:
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
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28
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Paraboschi I, Privitera L, Loukogeorgakis S, Giuliani S. Indocyanine Green-Based Fluorescence-Guided Surgery in a Male Infant with Anorectal Malformation. European J Pediatr Surg Rep 2022; 10:e122-e125. [PMID: 36016646 PMCID: PMC9398569 DOI: 10.1055/s-0042-1750029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/22/2022] [Indexed: 11/02/2022] Open
Abstract
Reconstructive techniques for complex anorectal malformations (ARMs) require intestinal pull-through on vascular pedicles. Traditionally, the visual inspection of the intestinal perfusion is the sole modality adopted to assess tissue viability. In this article, we report the case of a child with a rectourethral prostatic fistula, who had a Peña's descending colostomy with distal mucous fistula in the neonatal period and a posterior sagittal anorectoplasty at 6 months of life. The ARM repair was guided by indocyanine green (ICG), which was intravenously administered to evaluate the blood flow of the intestinal pull-through using the EleVision IR system (Medtronic Ltd, U.K.). ICG-based fluorescence-guided surgery helped to define the proximal resection margin, impacting intraoperative decision making, and no postoperative complications occurred. We envisage that this technology will become part of the armory of pediatric surgeons soon, by reducing the risk of intra- and postoperative complications.
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Affiliation(s)
- Irene Paraboschi
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, United Kingdom
| | - Laura Privitera
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, United Kingdom
| | - Stavros Loukogeorgakis
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, United Kingdom
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Cancer Section, Department of Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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29
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Abstract
Fecal incontinence (FI) is a commonly occurring disease of high concern. It is characterized by voluntary and involuntary defecation in children and adolescents. It is not only a physical disease but also a psychological and behavioral disorder. FI poses a serious burden on individuals and their families and therefore has become a social problem. Unfortunately, the management of FI among children is still a challenge because the etiology varies widely. Constipation has been found to be the most common cause, while sphincter dysfunction and neurogenic abnormalities may also play a role. Currently, no consensus guidelines exist, and the criteria for selecting optional methods remain unclear. It is therefore necessary to improve the efficacy of diagnosis and management strategies of FI in children. This review focused on the classification and etiology, discussed the diagnosis and management methods of FI in children and adolescents, and aimed to guide future studies.
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Affiliation(s)
- Zhe-Ying Shen
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Zhang
- Department of Pediatric Orthopedics, Dalian Women and Children's Medical Center, Dalian, China
| | - Yu-Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shu-Cheng Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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30
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Connor SJ, Brisighelli G, Patel N, Levitt MA. Clinical Quiz-A Rare Case of Anal Canal Duplication in the Context of Currarino Syndrome. European J Pediatr Surg Rep 2021; 9:e68-e71. [PMID: 34777941 PMCID: PMC8580735 DOI: 10.1055/s-0041-1735595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Currarino syndrome (CS) is a rare condition that presents with any combination of a sacral defect, a presacral mass, and an anorectal malformation. This collection, referred to as Currarino's triad, may not necessarily present as all three abnormalities in the diagnosis of the syndrome. Anal canal duplication (ACD) is an even rarer occurrence. We present a case that lies on the CS spectrum with an associated ACD and discuss a complex surgical challenge that necessitated a customized management plan, devised through a multidisciplinary approach.
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Affiliation(s)
- Sean Jared Connor
- Department of Paediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, Gauteng, South Africa.,University of the Witwatersrand School of Clinical Medicine, Johannesburg, Gauteng, South Africa
| | - Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, Gauteng, South Africa
| | - Nirav Patel
- Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Marc A Levitt
- Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
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31
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Chatterjee US, Basu AK, Das S, Mitra D. Abdominoperineal Tunnel Crafted with Alken's Telescopic Dilators: A Novel Technique! J Indian Assoc Pediatr Surg 2021; 26:334-335. [PMID: 34728920 PMCID: PMC8515534 DOI: 10.4103/jiaps.jiaps_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Abdomino-perineal pull through procedure needs perineal dissection and for that swap of supine to prone may be necessary. To avoid that as well as to avoid neuro-muscular damage; we are describing a simple minimal invasive procedure with help of Alken's telescopic dilators. Patients & Methods We created abdomino-perineal tunnel with Alken's telescopic dilators to bring down the lumen of intestine in perineum in eight patients. Results Operative time happened to be less and procedure found to be less traumatic. All the eight patients had satisfactory outcome. Conclusions Actually, we have repurposed the Alken's dilator for creation of abdomino-perineal tunnel or track to get benefit of minimal dissection of perineum during pull-through procedure as well as to avoid neuro-muscular damage.
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Affiliation(s)
| | - Ashoke Kumar Basu
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Sachchidananda Das
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Debashis Mitra
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
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32
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Wester T, Gunnarsdottir A, Skoglund C, Svenningsson A. Attention deficit hyperactivity and autism spectrum disorders in patients with anorectal malformations. Acta Paediatr 2021; 110:3131-3136. [PMID: 34498328 DOI: 10.1111/apa.16100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
AIM To assess the risk of neurodevelopmental disorders in patients with anorectal malformations compared to controls. METHODS This was a population-based cohort study including all patients born in Sweden 1997-2012 with anorectal malformation in the Swedish National Patient Register and five matched controls per patient. Anorectal malformation was the exposure. All individuals were evaluated for the outcomes, attention deficit hyperactivity disorder or autism spectrum disorder in the National Patient Register. Data on drugs for attention deficit hyperactivity disorder were retrieved from the Swedish Prescribed Drug Register and used as proxy for attention deficit hyperactivity disorder. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Analyses were adjusted for confounders. RESULTS Five hundred and fifteen patients with anorectal malformations and 2560 controls were included. Patients with anorectal malformation had a higher risk of attention deficit hyperactivity disorder (OR 3.01 (95% CI, 1.83-4.95)) and autism spectrum disorders (OR 3.07 (95% CI, 1.62-5.79)) compared to the controls. Significantly more patients with anorectal malformation had been prescribed medication for attention deficit hyperactivity disorder compared to controls (OR 2.26 (95% CI 1.33-3.85)). CONCLUSION Patients with anorectal malformations have a higher risk of attention deficit hyperactivity disorder and autism spectrum disorders than controls.
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Affiliation(s)
- Tomas Wester
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Anna Gunnarsdottir
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | | | - Anna Svenningsson
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
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33
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Ishimaru T, Kawashima H, Hayashi K, Oiki H, Omata K, Sanmoto Y, Inoue M. A Comparison of Sexual Function in Male Patients with Anorectal Malformations Between the Conventional and Laparoscopic Approaches. J Laparoendosc Adv Surg Tech A 2021; 31:1420-1423. [PMID: 34669516 DOI: 10.1089/lap.2021.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To compare the incidence of erectile dysfunction and ejaculatory anomalies in male patients with anorectal malformation (ARM) after treatment with the sacroperineal approach (Group S) or laparoscopically assisted anorectoplasty (LAARP; Group L). Methods: Male patients who underwent repair of high- or intermediate-type ARMs at our center and aged ≥15 years as of November 2020 were enrolled. Patients with intellectual disabilities or chromosomal disorders were excluded. Sacroperineal anorectoplasty has long been routinely performed at our hospital, and LAARP was introduced as a standard procedure in 2000. The medical records of the outpatient clinic were retrospectively reviewed, and questionnaires were sent in November 2020. Data regarding erectile dysfunction, ejaculatory anomalies, and associated anomalies were collected and compared between the two groups. Results: Answers were obtained from 7/22 patients in Group S (32%) and 10/17 patients in Group L (59%). Patient characteristics were similar, but the median age at the time of replying was significantly different (22 [18-29] years in Group S and 19 [15-20] years in Group L, P = .0060). None of the patients had erectile dysfunction, but 3 patients in Group S (43%) and 5 patients in Group L (50%) had ejaculatory failure, with no significant difference between the two groups. Conclusions: The incidence of sexual dysfunction in male patients with ARM might be higher than that in the healthy population. Patients might abscond from their follow-up visits as they age; therefore, providing patients with accurate information on this issue before puberty is essential.
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Affiliation(s)
- Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Hayashi
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hironobu Oiki
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kanako Omata
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yohei Sanmoto
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Maho Inoue
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Lacher M, Badillo A, Vilanova-Sánchez A, Rentea RM, Gosemann JH, Levitt MA. Laparoscopic Approach in Anorectal Malformations: How We Do It. J Laparoendosc Adv Surg Tech A 2021; 31:1200-1208. [PMID: 34551270 DOI: 10.1089/lap.2021.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laparoscopy has a major role in the treatment of anorectal malformations (ARM) since Georgeson et al. introduced the laparoscopic assisted anorectoplasty in 2000. The majority of ARM can be repaired through a posterior sagittal incision without the need to enter the abdomen. Some ARM types require an abdominal approach to detach the rectum from the urinary tract in males or the vagina in females. Those malformations benefit from laparoscopy. In this article, we aimed to highlight the technical aspects relevant to the current laparoscopic repair of ARM.
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Affiliation(s)
- Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, USA
| | - Alejandra Vilanova-Sánchez
- Urogenital and Colorectal Unit, Department of Pediatric Surgery, University Hospital La Paz, Madrid, Spain
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, USA
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35
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Theodorou CM, Trappey AF, Chen SA, McCracken K, Saadai P. Surgical Management of an Obstructive Müllerian Anomaly in a Patient with Anorectal Malformation. J Pediatr Surg Case Rep 2021; 71:101908. [PMID: 34414074 DOI: 10.1016/j.epsc.2021.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Müllerian duct anomalies are rare in the general population, occurring in less than 3% of women, but much more prevalent in female patients with anorectal malformation, occurring in up to 30% of these patients. Unicornuate uterus with a rudimentary non-communicating horn is a congenital anomaly of Mullerian development which can be seen in isolation or in conjunction with other anomalies, with several case reports described in patients with VACTERL association. These anomalies may be asymptomatic until the patient develops dysmenorrhea or devastating obstetrical complications. We describe the successful surgical management of an obstructive Müllerian anomaly in a post-pubertal female patient with anorectal malformation.
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Naji H, Ali Hassan R. Perineal Groove: Is It More Common Than We Think? Clinical Characteristics of Four Cases and Review of Literature. Pediatr Rep 2021; 13:490-4. [PMID: 34449719 DOI: 10.3390/pediatric13030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Perineal groove is a very rare congenital malformation that usually occurs in females. It has been described as a wet, un-epithelialized mucus tissue extending from the posterior vaginal fourchette to the anterior anal opening. It is generally asymptomatic and self-limited. Due to its rarity, it is often unfamiliar to clinicians, often leading to a missed diagnosis or unnecessary interventions. Methods: During the period from September 2017 to September 2020, four patients (two newborns and 2 infants) were diagnosed with perineal grooves. They were referred to the pediatric surgery clinic because of abnormal findings during their genital examinations. During the same period of time, the clinic received 12 other new patients with various forms of anorectal malformations. Results: All four patients were girls. During examinations by their respective pediatricians, an abnormality in the perineum was noted in each of the patients. The depth of the grooves varied between the four patients and extended from the anus to the vaginal fourchette. None of the patients experienced any other symptoms related to the malformation. All the cases were referred to the pediatric surgeon by their pediatricians as a diagnosed anal fissure or abnormal finding in the genitalia. In all four patients, the mothers did not take folic acid during the pregnancy. The four patients were observed, and no surgery was needed; in three of the cases, there was a complete spontaneous resolution while the fourth patient still remains under observation. Conclusions: Perineal groove is a rare malformation with a low incidence rate. It is more common in female infants and usually self resolves before the age of 2 years. The condition is diagnosed on clinical examination; however, it is easily misdiagnosed and may lead to unnecessary interventions and surgery.
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Jun LH, Jacobsen A, Rai R. Case Report: A Case Series of Rare High-Type Anorectal Malformations With Perineal Fistula: Beware of Urethral Involvement. Front Surg 2021; 8:693587. [PMID: 34336920 PMCID: PMC8320771 DOI: 10.3389/fsurg.2021.693587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Anorectal malformations (ARMs) are one of the more common congenital anomalies encountered in pediatric surgery where the majority are diagnosed in the early neonatal period. The etiology of ARM remains uncertain and is likely to be multifactorial. A majority of ARMs result from abnormal development of the urorectal septum in early fetal life. There can be a broad range of presentation features varying from low anomalies with perineal fistula to high anomalies mandating intricate management. To develop a standardized system for comparison in follow-up studies, the Krickenbeck classification was introduced according to the type of fistula. According to the Krickenbeck classification of ARM, those with a rectoperineal fistula are classified as low-type ARM and are usually managed with a perineal anoplasty without colostomy. In this case series, we describe two rare cases of distinct high and intermediate ARM with rectoperineal fistulas, which were thought to be low-type ARM but were subsequently found to have urethral involvement. Our cases consisted of high and intermediate ARMs, which were successfully treated with posterior sagittal anorectoplasty as described. These cases exemplified rare variants of ARM where rectoperineal fistulas can be associated with high-type anomalies. Rare-variant ARM with rectopenile or rectoscrotal fistula can be associated with high-type anomalies in contrast to classical rectoperineal fistulas. A high index of suspicion should remain in cases with previous urinary tract infection despite normal imaging. Careful planning is also needed with consideration of possible need for urethral repair during anoplasty, which was needed in both our cases.
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Affiliation(s)
- Lim Hui Jun
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anette Jacobsen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rambha Rai
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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Dessanti A, Louisma O, Pierre GS, Liem NT. Anorectal Malformation with Rectovestibular Fistula and Vaginal Agenesis: Usage of Rectovestibular Fistula as a Neovagina Followed by PSARP with Preservation of the Anal Sphincter. European J Pediatr Surg Rep 2021; 9:e51-e55. [PMID: 34277324 PMCID: PMC8276751 DOI: 10.1055/s-0041-1728725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Anorectal malformation with rectovestibular fistula associated with vaginal agenesis is rare. We report on a child in whom this combination was diagnosed at the age of 1 year. After creation of a divided descending colostomy, we chose to leave the rectum-rectovestibular fistula to function as a neovagina, while the sigmoid colon was relocated via modified posterior sagittal anorectoplasty. The colostomy was closed 6 months after the main surgery. After a follow-up of 3 years, the patient is continent for stool and urine. The introitus of the neovagina appears wide and easy to explore. We conclude that our surgical approach may be a good option for these children.
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Affiliation(s)
| | - Osnel Louisma
- Department of Pediatric Surgery, Saint Damien Children Hospital, Port Au Prince, Haiti
| | - Gabriel Steve Pierre
- Department of Pediatric Surgery, Saint Damien Children Hospital, Port Au Prince, Haiti
| | - Nguhien Thanh Liem
- Department of Pediatric Surgery, National Children Hospital and Vinmec International Hospital, Hanoi, Vietnam
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Woods C, Kapur RP, Bischoff A, Lovell M, Arnold M, Peña A, Flockton A, Sharkey KA, Belkind-Gerson J. Neurons populating the rectal extrinsic nerves in humans express neuronal and Schwann cell markers. Neurogastroenterol Motil 2021; 33:e14074. [PMID: 33382200 DOI: 10.1111/nmo.14074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/27/2020] [Accepted: 12/14/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND In mice, Schwann cell (SC) progenitors give rise to autonomic ganglion cells and migrate into the gut to become enteric neurons. It is unknown whether SC progenitors have a similar fate in humans. In search of evidence for human SC-derived neurogenesis in the gastrointestinal (GI) tract, we studied the rectums from cadaveric controls and children with anorectal malformations (ARM). METHODS We analyzed distal rectal tissue taken at autopsy from 10 children with normal GI tracts and resected rectal specimens in 48 cases of ARM. Of these specimens, 6 had neurons within the extrinsic rectal innervation. These were further investigated with immunohistochemistry for neuronal and SC/glial markers. KEY RESULTS Perirectal tissue from control and ARM contained GLUT1-positive extrinsic nerves, many containing neurons. SC/glial markers (SOX10, CDH19, and PLP1) were expressed by glia in the enteric nervous system and perirectal nerves, while MPZ predominated only in glia of perirectal nerves, in both control and ARM. Neurons in perirectal nerves were 61% larger in ARM samples and co-expressed SOX10 (81%), PLP1 (73%), and CDH19 (56%). In ARM, cytoplasmic SOX10 was co-expressed with neuronal antigens in ~57% of submucosal and myenteric neurons, vs. ~3% in control. Furthermore, intrinsic gut neurons in ARM specimens co-expressed PLP1 (18%) and CDH19 (18%); however, neuronal co-expression of PLP1 and CDH19 was rarely (<2%) observed in controls. CONCLUSIONS & INFERENCES Dual expression of glial and neuronal markers in rectal and perirectal neurons support a model of Schwann cell-derived neurogenesis in the innervation of the human GI tract.
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Affiliation(s)
- Crystal Woods
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Raj P Kapur
- Department of Pathology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Andrea Bischoff
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Mark Lovell
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael Arnold
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Alberto Peña
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Amanda Flockton
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Keith A Sharkey
- Department of Physiology & Pharmacology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaime Belkind-Gerson
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado, Aurora, CO, USA.,Neurogastroenterology and Motility Program, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, USA
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Agrawal V, Tiwari A, Sharma D, Mishra R, Acharya H. Comparison of 3D vs 2D laparoscopic-assisted anorectal pull-through (LAARP) for high anorectal malformations in children. Asian J Endosc Surg 2021; 14:424-431. [PMID: 33145992 DOI: 10.1111/ases.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The limitation of two-dimensional (2D) laparoscopic techniques includes lack of stereoscopic vision and depth perception which can affect surgical performance, physical and mental comfort of the operating surgeon. 3D laparoscopic surgery is popular in adults; however, its application and experience in the pediatric age group have been limited. We did a comparison of 2D and 3D laparoscopic-assisted anorectal pull-through (LAARP) in male high anorectal malformations (ARM). MATERIAL AND METHOD This prospective cohort study included male children diagnosed with high anorectal malformation (recto-prostatic urethral fistula) who underwent LAARP in infancy after a neonatal colostomy between November 2019 to March 2020. The patients were randomized into a 2D group or 3D group at a 1:1 ratio. Patient demographics and operative/postoperative parameters were recorded. The effect of 3D laparoscopy was assessed in terms of laparoscopy visual parameters (image quality, depth perception, hand-eye coordination, and precision), physical discomfort (5-point Likert scale), and mental strain (State-Trait Anxiety Inventory scale). The statistical tests were performed on SPSS version 16. RESULTS The demographics of both groups, 20 (patients in each), were similar. There was a significant reduction of laparoscopy execution time, physical discomfort (for eye, hand and wrist strain), and overall mental strain in the 3D group. There were similar complications, blood loss, and hospital stay, and no open conversion in two groups. CONCLUSION 3D LAARP is feasible and safe in the surgical treatment of ARM in children. Further studies with assessment by more than one observer are needed to investigate the wider application of 3D in pediatric surgery.
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Affiliation(s)
- Vikesh Agrawal
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Abhishek Tiwari
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Rajesh Mishra
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Himanshu Acharya
- Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
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Ishimaru T, Kawashima H, Hayashi K, Omata K, Sanmoto Y, Inoue M. Laparoscopically assisted anorectoplasty-Surgical procedures and outcomes: A literature review. Asian J Endosc Surg 2021; 14:335-345. [PMID: 33029900 DOI: 10.1111/ases.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
Anorectal malformation includes various types of anomalies. The goal of definitive surgery is achievement of fecal continence. Twenty years have passed since laparoscopically assisted anorectoplasty (LAARP) was reported by Georgeson. Since LAARP is gaining popularity, its long-term outcomes should be evaluated. Presently, there is no evidence regarding the optimal method of ligating and dividing the fistula correctly and creating the pull-through canal accurately. Rectal prolapse and remnant of the original fistula (ROOF) tend to develop more often in LAARP patients than in posterior sagittal anorectoplasty (PSARP) patients; however, robust evidence is not available. Prolapse may be prevented by suture fixation of the rectum to the presacral fascia; however, if prolapse occurs, the indication, timing, and the best method for surgical correction remain unclear. Most patients with ROOF are asymptomatic, and there is controversy regarding the indications for ROOF resection. This article aimed to detail the various modifications of the LAARP procedures reported previously and to describe the surgical outcomes, particularly focusing on rectal prolapse, ROOF, and fecal continence, by reviewing the literature. Functional outcomes after LAARP were almost similar to those noted after PSARP, and we have demonstrated that LAARP is not inferior to PSARP with respect to fecal continence. Although there is controversy regarding the application of LAARP for recto-bulbar cases, we believe that LAARP is still evolving, and we can achieve better outcomes by improving the procedure.
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Affiliation(s)
- Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Hayashi
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kanako Omata
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yohei Sanmoto
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Maho Inoue
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Lopez JJ, Svetanoff WJ, Rosen JM, Carrasco A, Rentea RM. Leveraging Collaboration in Pediatric Multidisciplinary Colorectal Care Using a Telehealth Platform. Am Surg 2021; 88:2320-2326. [PMID: 34105388 DOI: 10.1177/00031348211023428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Pediatric colorectal problems often require complex multidisciplinary care (MDC), which has been affected by the SARS-CoV-2-2019 (COVID-19) pandemic. We describe our utilization and implementation of telehealth (TH) for pediatric colorectal surgery MDC visits and collate patient satisfaction using TH compared to in-person (IP) visits. METHODS Implementation of a single-institution MDC TH platform to perform patient visits on February 1, 2020 was studied. Following 6 months of implementation, TH visits' characteristics were compared with IP visits in the 3 months before implementation by patient volume, length of clinic visits, and patient satisfaction survey results. RESULTS Before implementation, 152 (100%) of clinic visits were IP. During the implementation, 87 (37.7%) were TH visits. Seventy-four (49%) were MDC visits, 17 (23%) of these using the TH platform. Each TH visit's median length was 25 minutes (IQR 15-30), while the median length of IP visits was 45 minutes (IQR 30-45). Pre-implementation satisfaction scores were 88.6% positive, while satisfaction scores after implementation were 96.8% positive. None of the patients who utilized the TH platform had an unplanned hospital admission within 24 hours of being seen. CONCLUSION Our experience demonstrates that the TH platform can provide an efficient avenue for established patients and families to receive highly complex multidisciplinary follow-up care. High levels of patient satisfaction indicated that TH should become part of the routine care plan for patients who require long-term or consistent follow-up.
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Affiliation(s)
- Joseph J Lopez
- Comprehensive Colorectal Center, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA.,Department of Pediatric Surgery, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA.,Department of Pediatric Surgery, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA
| | - John M Rosen
- Department of Pediatric Gastroenterology, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA
| | - Alonso Carrasco
- Department of Pediatric Urology, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA.,Department of Pediatric Surgery, 4204Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO, USA
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Aihole JS. Persistent Left Superior Vena Cava: A Rare Association. Glob Pediatr Health 2021; 8:2333794X211015527. [PMID: 34104691 PMCID: PMC8150421 DOI: 10.1177/2333794x211015527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most frequent abnormality in the general population with the frequency of 0.1% to 0.5%. It results from the failure of the involution of the left anterior cardinal vein. Right and Left SVC can coexist together in 80% to 90% of cases. Association of PLSVC with ano rectal malformation (ARM) is very rarely reported. Hence, here is a report of a unique case of PLSVC in a female neonate with ARM.
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Smith CA, Avansino JR, Merguerian P, Lane V, Levitt M. A Novel Surgical Approach for the Management of Cloacal Exstrophy with a Giant Omphalocele. European J Pediatr Surg Rep 2021; 9:e41-e45. [PMID: 34026419 PMCID: PMC8131127 DOI: 10.1055/s-0041-1728719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
Cloacal exstrophy is a rare malformation that presents as a lower midline abdominal wall defect which affects the gastrointestinal and genitourinary systems. The components of cloacal exstrophy characteristically include omphalocele, exstrophy of perineal structures, and imperforate anus. Most of these patients also have renal anomalies such as pelvic kidney, fused kidneys, or solitary kidneys. This congenital condition can also be associated with spinal issues, such as spinal dysraphism. When combined with spinal defects, it is referred to as the omphalocele, exstrophy, imperforate anus, and spinal defects (OEIS) complex, and is one of the most challenging surgical conditions to manage. Here, we present a unique case of a low-birth-weight patient with OEIS and a liver containing giant omphalocele and the novel surgical technique used to manage her cloacal exstrophy whereby the cecal plate was not separated from the bladder halves, but rather left for an autoaugment, and the ileum was connected to the hindgut.
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Affiliation(s)
- Caitlin A Smith
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, United States
| | - Jeffrey R Avansino
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, United States
| | - Paul Merguerian
- Department of Urology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, United States
| | - Victoria Lane
- Department of Surgery, The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Marc Levitt
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
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Erculiani M, Zanatta C, Vidal E, Martelossi S, Midrio P. Ulcerative Colitis of the Neovagina in a Toddler with Cloaca and Chronic Kidney Disease. European J Pediatr Surg Rep 2021; 9:e33-e36. [PMID: 34026418 PMCID: PMC8131128 DOI: 10.1055/s-0041-1726868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022] Open
Abstract
The case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy.
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Affiliation(s)
- Marta Erculiani
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Cinzia Zanatta
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Enrico Vidal
- Division of Pediatrics, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Friuli-Venezia Giulia, Italy
| | - Stefano Martelossi
- Division of Pediatrics, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Paola Midrio
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
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Maistry N, Brisighelli G, Westgarth-Taylor C. Posterior Cloacal Variant with Clitorolabial Transposition and a Rectoperineal Fistula. European J Pediatr Surg Rep 2021; 9:e46-e49. [PMID: 34026420 PMCID: PMC8131129 DOI: 10.1055/s-0041-1728724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/06/2021] [Indexed: 11/08/2022] Open
Abstract
We present a case and discuss the management of a posterior cloacal variant not as yet described in the literature. A 5-week-old infant presented to our institution with a posterior cloacal variant and transposition of the clitoris and labia. After initial radiological investigations, staged operative intervention was performed over a 1-year period. This included an initial laparotomy (with drainage of hydrocolpos and formation of a colostomy), a left ureteric reimplantation and a posterior sagittal anorectoplasty due to a rectoperineal fistula. The child is under continued long-term follow-up by our specialist pediatric surgical team.
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Affiliation(s)
- Niveshni Maistry
- Department of Paediatric Surgery, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, Gauteng, South Africa
| | - Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, Gauteng, South Africa
| | - Chris Westgarth-Taylor
- Department of Paediatric Surgery, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, Gauteng, South Africa
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Svetanoff WJ, Ahmed A, Hendrickson RJ, Rentea RM. Neonatal Renal Failure in the Setting of Anorectal Malformation: A Case Report and Literature Review. Cureus 2021; 13:e14984. [PMID: 34123676 PMCID: PMC8194500 DOI: 10.7759/cureus.14984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anorectal malformations (ARMs) can occur in isolation or in association with other anomalies, most commonly those of the genitourinary systems. Morbidity and mortality are highest among patients who develop end-stage renal disease (ESRD) either from severe congenital anomalies (dysplastic kidneys) or from repeated infections in those who have vesicoureteral reflux or persistent recto-urinary fistulas. We describe our management strategy for a patient born with an ARM and bilateral dysplastic kidneys to highlight the nuances and complex decision-making considerations required in taking care of this complex patient population. Our patient is a male twin born at 32 weeks' gestational age who was found to have bilateral dysplastic kidneys on prenatal ultrasound. On initial examination, an imperforate anus was identified along with a severe urethral stricture. Full workup also revealed sacral dysgenesis and confirmation of the dysplastic kidneys. On day of life 3, a laparoscopic diverting sigmoid colostomy was performed; urologic evaluation confirmed the severe urethral stricture, which required dilation to place an 8F council tip catheter. Due to his small size, peritoneal dialysis could not be initiated until five weeks of age. As full volumes could not be reached with peritoneal dialysis, he was soon transitioned to continuous renal replacement therapy. At five months of age, a laparoscopic-assisted posterior sagittal anorectoplasty (PSARP) was performed. As his urethral stricture had worsened, a suprapubic catheter had been placed for bladder decompression. Reversal of his colostomy was performed 15 days after PSARP. Unfortunately, the patient required three further surgical interventions due to abdominal wall and inguinal hernias contributing to filling and emptying dysfunction when utilizing peritoneal dialysis. He is currently 16 months of age and remains inpatient due to intermittent hemodialysis requirements along with autocycling of his peritoneal dialysis. He is working on developmental milestones, can pull to a stand, and is currently being evaluated for kidney transplantation. The development of ESRD in a neonate or infant with an ARM is rare and can be due to congenital dysplasia or agenesis of bilateral kidneys. While peritoneal dialysis is the preferred approach, catheter dysfunction can result from intra-abdominal adhesions or inadequate fluid removal from inguinal or abdominal wall hernias that form in the setting of increased intra-abdominal pressure required for peritoneal dialysis. Close collaboration is required between pediatric surgeons, nephrologists, and urologists to facilitate colonic and urologic reconstruction and manage catheter-related complications.
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Affiliation(s)
| | - Asma Ahmed
- General Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Richard J Hendrickson
- Pediatric Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rebecca M Rentea
- Pediatric Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
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48
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Kaji T, Maeda K, Sogawa E, Yoshida A, Yonetani N, Ishibashi H, Irahara M, Iwasa T. Sonographic detection and localization of fistulas in fetuses with imperforate anus: Case reports. J Obstet Gynaecol Res 2021; 47:2767-2772. [PMID: 33973314 DOI: 10.1111/jog.14824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
Imperforate anus (IA) requires urgent treatment after birth, which is dependent on the type of IA, and is also frequently associated with other congenital abnormalities. Most patients with IA have an accompanying fistula, whose location is strongly associated with the type of IA. The fistula location can be a key factor in defining appropriate treatment, especially in neonates presenting with severe associated abnormalities. Herein, we report three cases of IA in which fistulas were detected and localized prenatally. Examination of the fetal pelvis through the sagittal or coronal view, using high-frequency transducers, revealed the location of the fistulas. In particular, the sagittal view obtained using the fetal infracoccygeal or perineal approach allowed us to determine the precise anatomy of the fistulas. Neonatal assessment confirmed the fistula locations. We recommend using the sagittal view obtained using the fetal infracoccygeal or perineal approach with high-frequency transducers to assess fistulas in fetuses with IA.
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Affiliation(s)
- Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Eishi Sogawa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Atsuko Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Naoto Yonetani
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroki Ishibashi
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Mosiello G, Safder S, Marshall D, Rolle U, Benninga MA. Neurogenic Bowel Dysfunction in Children and Adolescents. J Clin Med 2021; 10:1669. [PMID: 33924675 PMCID: PMC8069792 DOI: 10.3390/jcm10081669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023] Open
Abstract
Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.
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Affiliation(s)
- Giovanni Mosiello
- Department of Surgery, Division of Urology, Bambino Gesù Pediatric and Research Hospital, 00165 Rome, Italy
| | - Shaista Safder
- College of Medicine, Center for Digestive, Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL 32806, USA;
| | - David Marshall
- Department of Pediatric Surgery and Pediatric Urology, Royal Belfast Hospital for Sick Children, Belfast BT97AB, UK;
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, Goethe-University Frankfurt, 60596 Frankfurt, Germany;
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
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Li SY, Wang CY, Xiao YX, Tang XB, Yuan ZW, Bai YZ. RNA-Seq Profiling of Circular RNAs During Development of Hindgut in Rat Embryos With Ethylenethiourea-Induced Anorectal Malformations. Front Genet 2021; 12:605015. [PMID: 33927745 PMCID: PMC8076906 DOI: 10.3389/fgene.2021.605015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Anorectal malformations (ARMs) are among the most common congenital terminal digestive tract malformations. Circular RNAs (circRNAs), a novel type of endogenous non-coding RNAs, play roles in the development of the digestive system; however, their contributions to the pathogenesis of ARMs are not well-established. In this study, we explored the mechanism underlying ethylenethiourea (ETU)-induced ARMs by profiling circRNA expression via RNA-seq and constructing a regulatory circRNA-miRNA-mRNA network. Nine pregnant rats were gavage-fed a single dose of 125 mg/kg 1% ETU (ARM group) on gestational day 10 (GD10), and another 9 pregnant rats received a similar dose of saline (normal group) as a control. Embryos were obtained by cesarean section on the key time-points of anorectal development (GD14, GD15, and GD16). Hindgut samples isolated from the fetuses were evaluated by high-throughput sequencing and differentially expressed circRNAs were validated by reverse transcription-quantitative polymerase chain reaction, agarose gel electrophoresis, and Sanger cloning and sequencing. A total of 18295 circRNAs were identified in the normal and ARM groups. Based on the 425 differentially expressed circRNAs (|Fc| > 2, p < 0.05), circRNA-miRNA and miRNA-mRNA pairs were predicted using miREAP, miRanda, and TargetScan. A total of 55 circRNAs (14 up- and 41 downregulated in the ARM group compared to the normal group) were predicted to bind to 195 miRNAs and 947 mRNAs. Competing endogenous RNA networks and a Kyoto Encyclopedia of Genes and Genomes analysis revealed that novel_circ_001042 had the greatest connectivity and was closely related to ARM-associated signaling pathways, such as the Wingless Type MMTV integration site family, mitogen-activated protein kinase, and transforming growth factor-β pathways. These results provide original insight into the roles of circRNAs in ARMs and provide a valuable resource for further analyses of molecular mechanisms and signaling networks.
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Affiliation(s)
- Si Ying Li
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chen Yi Wang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yun Xia Xiao
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zheng Wei Yuan
- The Key Laboratory of Health Ministry for Congenital Malformation, Shenyang, China
| | - Yu Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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