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Zarzecki MP, Ostrowski P, Wałęga P, Iwanaga J, Walocha JA. The middle anorectal artery - a systematic review and meta-analysis of 880 patients / 1905 pelvic sides. Clin Anat 2022; 35:934-945. [PMID: 35474241 DOI: 10.1002/ca.23898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The middle anorectal artery (MAA) is considered to supply the middle and lower parts of the rectum however its prevalence and point of origin vary across the literature. Clinical importance of the MAA becomes evident in the total mesorectal excision during the colorectal surgery of rectal cancer in both sexes, as well as interventional radiology procedures utilizing the prostatic vasculature in males. MATERIALS AND METHODS Major electronic medical databases were investigated for terms pertaining to the MAA and its associated variations. Compatible data regarding the artery's prevalence, laterality, origin, and distribution in both sexes was acquired. The risk of bias within the studies was assessed utilizing the AQUA tool. RESULTS In total, 28 works (n=880 patients / 1905 pelvic sides) were included in this systematic review and meta-analysis, and their publication date ranged from 1897 until 2021. The overall pooled prevalence estimate for the MAA was 59.8% of the patients, and 55.2% of the pelvic sides studied. The vessel was identified more frequently in cadaveric pelvic sides evaluations (79.3%). The artery was found bilaterally more often (56.7%), and most commonly originated from the internal pudendal artery (50.3%). Anastomoses between the MAA and the other anorectal arteries were reported in 78.1%. CONCLUSIONS The MAA is predominantly a present vessel, with various point of origin. Its direct clinical significance is yet to be discovered in larger study samples, providing more detailed and unified reports of its anatomical features, especially regarding its branches.
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Affiliation(s)
- Michał P Zarzecki
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,International Evidence-Based Anatomy Working Group, Cracow, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Wałęga
- 3rd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,International Evidence-Based Anatomy Working Group, Cracow, Poland
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Wang Y, Dai X, Liu H, Li Y, Li L, Chen J. Anal atresia as the diagnostic clue in VACTERL association: A first-trimester case report. J Obstet Gynaecol Res 2021; 47:3702-3706. [PMID: 34365700 DOI: 10.1111/jog.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
Anal atresia is the most common malformation occurring in VACTERL association, but it is difficult to diagnose antenatally. We herein present a case of fetal anal atresia in VACTERL association diagnosed by ultrasonography and supported by autopsy. This case emphasizes the clues to ultrasonographic diagnosis of anal atresia at 11-13+6 weeks of gestation, promoting increased awareness of VACTERL association during first-trimester screening.
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Affiliation(s)
- Yu Wang
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaohui Dai
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Yiping Li
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Jiao Chen
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Mboyo A, Aubert D, Vrsansky P. An exceptional type of anorectal malformation: anorectal atresia with posterior fistula in a newborn male. J Pediatr Surg 2006; 41:e7-9. [PMID: 16481236 DOI: 10.1016/j.jpedsurg.2005.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors report the case of a newborn male with an exceptional type of anorectal atresia with a fistula that passes posterior to the muscle complex and exits at a site just to the tip of the coccyx. This anorectal malformation was associated with other abnormalities including agenesis of the right kidney, pyelic dilatation of the left kidney, duplicity, and left megaureter. There was no defect in the spine. The anorectal malformation was managed successfully by a posterior sagittal approach according to the Pena procedure.
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Affiliation(s)
- Antoine Mboyo
- Department of Pediatric Surgery, Centre Hospitalier et Universitaire de Besançon, 25030 Besançon, France
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Arestis NJ, Clarke C, Munro FD, Micallef C, O'Sullivan MJ. Congenital pouch colon (CPC) associated with anorectal agenesis: a case report and review of literature. Pediatr Dev Pathol 2005; 8:701-5. [PMID: 16222474 DOI: 10.1007/s10024-005-0082-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N J Arestis
- Department of Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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Gangopadhyay AN, Shilpa S, Mohan TV, Gopal SC. Single-stage management of all pouch colon (anorectal malformation) in newborns. J Pediatr Surg 2005; 40:1151-5. [PMID: 16034761 DOI: 10.1016/j.jpedsurg.2005.03.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/PURPOSE The standard procedure in the management of pouch colon is the staged procedure (SP), which has well-known disadvantages. We believe that staging is unnecessary and primary single-stage procedure (PSSP) can be done. METHODS Patients with pouch colon who underwent PSSP (102 cases from 1997 to 2003) and SP (98 cases from 1991 to 1997), 63 and 42 of whom, respectively, were in regular follow-up for more than 3 years, were evaluated. RESULTS In PSSP, male/female ratio was 94:8; in SP, 89:9. Mean age in PSSP was 4.6 days and in SP 26 months. The distribution of cases into types I, II, III, and IV was 10, 24, 14, and 15 in PSSP, and 8, 20, 10, and 4 in SP, respectively. The ratio of PSSP/SP for total pouch colon (I and II) was 34:28 and for partial pouch colon (III and IV) was 29:14. The ratio of PSSP/SP in terms of continence, mortality, and cost was 75:48, 11:47, and 1:4, respectively. CONCLUSIONS Primary single-stage procedure gives better continence and cosmesis, with low morbidity and mortality at a low cost, and hence is recommended.
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Affiliation(s)
- A N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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Bangroo AK, Tiwari S, Khetri R, Sahni M. Congenital pouch colon with prune belly syndrome and megalourethra. Pediatr Surg Int 2005; 21:474-7. [PMID: 15868169 DOI: 10.1007/s00383-005-1439-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2005] [Indexed: 10/25/2022]
Abstract
Congenital pouch colon (CPC), an unusual high anorectal malformation in which a varying length of colon is replaced by a dilated pouch, has appeared in a number of case reports and series published in the English literature. There is only one case report of its association with prune belly syndrome (also known as triad syndrome, Eagle-Barrett syndrome, and abdominal muscle deficiency syndrome). We report the description and management of this rare association in a male neonate with CPC, prune belly syndrome, and congenital megalourethra.
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Affiliation(s)
- A K Bangroo
- Department of Pediatric Surgery, 1.3 Administration Block, St. Stephen's Hospital, Tis Hazari, Delhi 110054, India.
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Abstract
BACKGROUND/PURPOSE The mechanism by which the cloaca becomes partitioned into a dorsal rectal part and a ventral genitourinary sinus has been the subject of speculation for more than a century. Despite repeated suggestions that partitioning of the cloaca by fusion of lateral folds does not occur, the concept continues to hold sway in many student and surgical texts. The authors reviewed the histologic and 3-dimensional appearance of the urorectal septum in human and rat embryos to see if there was any evidence of lateral fusion in its formation. METHODS Sprague-Dawley rat embryos (n = 143) were examined between 11 and 21 days' gestation and compared with human embryo sections (57 embryos) held in historical collections in Europe. Rat embryos were examined by microscopy, dissection, and serial histologic section. In addition, some specimens were sectioned in wax until the lumen of the cloaca was reached, after which they were dewaxed and the internal cavities imaged with scanning electronmicroscopy (n = 18 of 143). RESULTS Cloacal "partitioning" resulted from a combination of growth of the mesenchyme of the hindgut and genitourinary sinus, an alteration in the position of the cloaca in relation to surrounding structures secondary to growth in the ventral, infraumbilical abdominal wall and changes in the curvature of the developing spine, and apoptosis in the dorsal wall of the cloaca with shortening of the dorsal cloacal wall. There was no septum, as it is usually defined, between the developing bladder and hindgut. There was no evidence on either histologic section or scanning electronmicroscopy of any process of fusion occurring between the 2 lateral folds within the lumen of the cloaca. CONCLUSIONS Lateral fusion of the side walls of the cloaca does not play a role in cloacal "partition." Development of the bladder and hindgut occurs by a process that involves growth, differentiation, and remodeling.
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Affiliation(s)
- E C Penington
- F. Douglas Stephens Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Australia
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Fritsch H, Kühnel W, Stelzner F. [Development and clinical anatomy of the rectal adventitia. significance for radical operation of rectal carcinoma]. LANGENBECKS ARCHIV FUR CHIRURGIE 1996; 381:237-43. [PMID: 8965599 DOI: 10.1007/bf00571693] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The development, topography and clinical anatomy of the adventitia recti were studied in 300- to 600-microns-thick sections through the pelves of human fetuses and newborn children and 5-mm sections through the pelves of adults. The adventitia recti constitutes a continuous compartment bordered laterally by the fascia recti. In the adult the adventitia recti consists mainly of adipose tissue. The extent of the adventitia recti differs in different parts of the rectal wall. The branches of the vasa rectalia superiora and the visceral lymph nodes of the rectum are situated within the adventitia recti. Our findings suggest that it is necessary to remove the adipose tissue of the adventitia recti and the adjoining lymph nodes individually during resection of the rectum in order to minimize the risk of tumor recurrence.
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Affiliation(s)
- H Fritsch
- Institut für Anatomie, Medizinische Universität Lübeck
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Chadha R, Bagga D, Malhotra CJ, Mohta A, Dhar A, Kumar A. The embryology and management of congenital pouch colon associated with anorectal agenesis. J Pediatr Surg 1994; 29:439-46. [PMID: 8201516 DOI: 10.1016/0022-3468(94)90588-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Forty-one infants with a pouch colon malformation accompanied by a high anorectal anomaly were treated between January 1986 and December 1990. The 41 cases constituted 9% of all anorectal malformations and 15.2% of high defects managed during this period. There were 32 boys and nine girls; three of the girls had an associated cloaca. Many of the babies presented in poor condition, with gross abdominal distension caused by the distended colonic pouch. The typical radiological feature was an enormously distended colonic shadow occupying more than 50% of the width of the abdomen. At the time of surgery, the patients were classified into 4 subgroups based on the length of the normal colon. All but three infants had a high wide fistula, with the genitourinary tract consisting of a colovesical fistula in males and a colovaginal or colocloacal fistula in females. Frequent associated malformations included duplication of the appendix and vesicoureteric reflux. The operations performed initially were a window colostomy of the pouch with or without division-ligation of the fistula, end-colostomy after fistula ligation, or subtotal pouch excision with tubularization of the remaining colon and end-colostomy. Thirteen of the 41 patients have undergone a definitive pull-through operation using the posterior sagittal approach, including two children in whom one-stage reconstruction of a cloaca was performed. Standardized management of this complex anomaly is proposed for the initial operation and for definitive reconstruction.
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Affiliation(s)
- R Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
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Abstract
The anal canal muscles development is studied in 18 human embryos. The external anal sphincter results to origin common with the urogenital sphincter from the cloacal sphincter. The muscle, after its appearance, is subdivided into two portions from a thin mesenchymal layer. Moreover, our embryologic study clearly confirms that the puborectalis muscle is a portion of the levator ani, its primordium being common with the ileo and the pubococcygeus muscles. The anal smooth musculature appears later than the striated one.
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Affiliation(s)
- A C Levi
- Department of Human Anatomy and Physiology, University of Turin, Osp. S. Vito, Italy
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Bourdelat D, Barbet JP, Hidden G. The morphological differentiation of the internal sphincter muscle of the anus in the human embryo and fetus. Surg Radiol Anat 1990; 12:151-2. [PMID: 2396181 DOI: 10.1007/bf01623343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D Bourdelat
- Service de Chirurgie Pédíatrique, Hôpital Delafontaine, Saint-Denis, France
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