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05-30-2008, 04:01 PM
(I) Low anomalies:
Definition:Those in which the termination of the bowel is below the pelvic floor.
1- Covered anus: Due to failure of rupture of proctodial membrane.
Treatment: Do cruciate incision in the membrane and excise its edges then suture the rectal mucosa to skin.
2-Congenital anal stenosis: (incomplete rupture of proctodial membane)
Treatment: Repeated dilatation.
3- Ectopic anus: may be in the post wall of vagina, vulva and perineum.
Treatment: Anal reconstruction & excision of the abnormal orifice.








(II) High anomalies:
1- With or without urinary fistula.

Anal aplasia.
2- Rectal aplasia.
3- Ano rectal aplasia.
4- Rectal atresia.




D.D between low and high anomaly
1- Pinch the skin at anus site if the membrane bulge, consistent with low anomaly. If no bulge, with high anomaly.
Meconium-filled track

2- If there is fistula, with high anomaly.
3- Coin test:
* Coin is put at the site of the anus.
* The patient is put inverted for 5 minutes to make gas content of intestine to raise up.
If the distance between coin and gas is:
] More than 2 cm High anomaly.
] Less than 2 cm Low anomaly. Or,
] If pubo coxygeal line passing through the gas low anomaly
] If it pass above it high anomaly.
What are the falacies of coin test:
1- Big pad of fat. (false high result)
2- Straining during x ray exposure. (false low result)
3- X-ray film is done before presence of air in the rectum.Best after 24 hours from birth time. (failure)
4- Viscid meconium in the terminal part of the rectum.(false high)
5- Deficient technique:
a- Inversion of the baby less than 5 minutes.
b- Center of X ray beam not centralized on the greater trochanter.
How can you detect presence of sphincter?
1- Pinching corrugations. 2- Electromyogrophy vibrations.
Treatment of aplasia.
High anorectal aplasia needs major operation, infant cann't withstand.
So; colostomy is done at 1st for 2 years then, anal reconstruction by abdomino perineal pull through operation.
SOURCE: DR. AYMAN SALEM'S BOOK
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