[size=20px]A one day old term female is found to have an imperforate anus. She has a smooth ovoid mass in her lower abdomen and over the course of the day develops difficulty urinating. An echocardiogram is normal. A bladder ultrasound shows a distended bladder with a cystic mass behind it.

 

The best next step in management of this patient with an anorectal malformation is

 

A invertogram lateral pelvic radiograph.

 

B upper gastrointestinal series.

 

C cystovaginoscopy.

 

D diagnostic laparoscopy.

 

E diverting colostomy.[/size]

(Untitled)

 

C

C

correct

 

The likely anomaly associated with the anorectal malformation in this little girl is hydrometrocolpos associated with cloaca and the distended and enlarged vagina can actually lead to obstruction of the urinary tract as well. Cystovaginoscopy would help to identify the anomaly, decompress the hydrometrocolpos and help in placing a bladder indwelling catheter if needed. A colostomy and likely vaginostomy will be needed at some point but is not the next best step.

 

The radiologic evaluations listed are not helpful in this case the invertogram will not help relieve the bladder or the vaginal fluid collections and an upper gasttointestinal series would not be useful.