TYPES OF DEFECTS ( classification )
MALE DEFECTS 1. Low Defects : Perineal fistula Median raphe fistula Bucket handle malformation Anal stenosis Anal membrane 2. Rectourethral bulbar fistula 3. Rectourethral prostatic fistula 4. Rectovesical ( bladder neck ) fistula 5. Imperforate anus without fistula 6. Rectal atresia and stenosisFEMALE DEFECTS
1. Low defect : Perineal fistula 2. Vestibular fistula 3. Vaginal fistula 4. Imperforate anus without fistula 5. Rectal atresia and stenosis 6. Persistent cloacaMALE DEFECTS 1. Low Defects : Perineal fistula
Median raphe fistulaBucket handle malformation
Anal stenosis Anal membrane
2. Rectourethral bulbar fistula3. Rectourethral prostatic fistula
4. Rectovesical (bladder neck ) fistula5. Imperforate anus without fistula
6. Rectal atresia and stenosis ( as in female )Female Defects
1. Low Defect : Perineal Fistula
2. Vestibular fistula 3 orifices3. Vaginal Fistula 2 orifices
4. Imperforate anus without fistula ( as in male )5. Rectal atresia and stenosis
6. Persistent cloaca 1 orificeN.B. Anteriorly displaced anus is a normal anus situated anteriorly
ASSOCIATED DEFECTS
Urogenital - Most common - 20 – 45 % The higher the malformation the higher the incidence Sacrum and Spine - Sacrum frequently abnormal deformed reduced in number hemisacrum - Spine frequently shows hemivertebraeCOLOSTOMY
- Type : sigmoid defunctioning with separate stomas - Site : junction of descending with sigmoid - Incision : left iliac , muscle cutting N.B. Distal loop should be cleared of meconium during operationDISTAL COLOSTOGRAM
- Most valuable test - Water soluble contrast into distal stoma - Significant pressure needed - Under fluoroscopic control - Contrast usually fills proximal urethra &bladder - Injection must continue till a voiding episode - Pictures taken during micturition- It shows in a single picture : sacrum height of rectum perineum fistula location bladder vesicoureteral reflux urethra No need for voiding cystourethrography or cystoscopy