[size=20px]A one-year old boy was born with an imperforate anus and a prostatic rectourethral fistula. He underwent a posterior sagittal anorectoplasty at five months of age with closure of his colostomy two months later. He has had three months of anal dilations. The parents are interested in knowing what they might be able to expect about his future anorectal function with regard to continence, constipation and the possibilities for interventions for improvement if needed.

 

In children with anorectal malformations which of the following would imply potentially good future anorectal function?

 

A short anal canal length

 

B low resting anal pressure

 

C low rectal volume to evoke a rectoanal inhibitory reflex

 

D prolonged pudendo-anal reflex

 

E removal of the fistula portion of the atretic rectum at anoplasty[/size]

A

Thank again my dear

A

Thank again my friend

C

C

correct

 

After repair of an anorectal malformation (ARM), infants and children frequently experience constipation and/or incontinence. An understanding of the physiologic differences between children with and without ARM can provide insight to the mechanisms of these difficulties, prognostic implications and the possibilities of intervention.

 

A number of reports indicate that infants and children having undergone repair of ARM have impaired anorectal function characterized by a

1- short anal canal length

2- low resting anal pressure

3- weak (or absent) rectoanal inhibitory reflex (RAIR, characterized by the requirement of a high rectal volume to evoke a response)

4- increased latency of the pudendo-anal reflex, spino-anal response and evoked potential of the cauda equina

 

The higher the level of anorectal malformation the worse the measurements. Improvement in these parameters has also been shown to correlate with improved bowel function. This has led to the institution of various interventions including biofeedback, nerve stimulation and laxative and enema management designed to address the particular deficiencies by tailoring programs to the particular patient characteristics and needs. Husberg has suggested that there is useful internal sphincter function in the fistula tissue in moderate to high imperforate anus as manifested by the presence of RAIR in a high proportion of these patients when the fistula is preserved in reconstruction.

Low resting anal pressure

Thanks for reply. Please see correct answer in post above yours