1. Imperforate Anus & Cloacal Malformation
Pediatric surgery
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ِِِAnomalies Anorectal
Imperforate Anus & Cloacal Malformation
Anorectal Malformation :
Occur in 1\4000 neonates, male > female , most common defect in boys is a rectourethral fistula, most common defect in girls is rectovestibular fistula

2. Types of imperforate anus:
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Types of imperforate anus:
The upside – down X – ray has been the classical method for determining the distance from the blind rectal pouch to a marker placed on or within the anal dimple.
According to pubococcygeal line (p – c) [ extended from the mid point at the pubis anteriorly to the coccyx ].
Low types.
Inter mediate.
High type.

3. Another classification of anorectal anomalies Colostomy requiredired
Pediatric surgery
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Another classification of anorectal anomalies
No need for colostomy
- Perineal ( cutaneaus ) fistula
- Recto urethral fistula
- Bulbar
BOYS Prostatic
- Recto vesicle fistula
- Imperforate anus without fistula
- Rectal atresia
Colostomy requiredired

4. Another classification of anorectal anomalies Colostomy requiredired
Pediatric surgery
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Another classification of anorectal anomalies
- Perineal ( cutaneaus ) fistula
- Vestibular F
- Persistent cloaca
GIRLS Imperforate anus without F.
- Rectal atresia
No need for colostomy
Colostomy requiredired

5. Clinical features: examination of:- Perineum
Pediatric surgery
د.حسن كريم كاطع
جامعة بغداد
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Clinical features: examination of:-
Perineum
Look for presence of anus , its size & site
Look for presence of an anal dimple
If there is an impulse on crying at the site of the anus , it denotes a low a normal
In ectopic anus, there is a subcutaneous fistulous tract full of meconium .
Meconium at the tip of the penis denotes a fistula to the bladder or urethra .

6. Abdomin General exam. Pediatric surgery جامعة بغداد كلية الطب
Abdomin
There may be evidence of intestinal obst.
General exam.
To exclude associated congenital Anomaly.

7. Pediatric surgery
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Investigation:-
Plain abdominal X – ray in the inverted position (invertogram).
The distance between radio opaque mark & the distal gas shadow is
Measured
If the distance > 1cm high anomaly
If the distance < 1cm low anomaly
Urine is examined for the presence of meconium , if present this denote a fistulous communication

8. Treatment: Persistent cloaca
Pediatric surgery
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Treatment:
All ano rectal anomalies can be corrected by posterior sagittal
Approach with or without laparotomy
Persistent cloaca
A defect in which rectum, vagina, urinary tract meet & fuse into a single common channal & absence of hymen, the length of common channel varies from 1 – 7 cm .

9. Pediatric surgery
د.حسن كريم كاطع
جامعة بغداد
كلية الطب