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de Blaauw I, Stenström P, Yamataka A, Miyake Y, Reutter H, Midrio P, Wood R, Grano C, Pakarinen M. Anorectal malformations. Nat Rev Dis Primers 2024; 10:88. [PMID: 39572572 DOI: 10.1038/s41572-024-00574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2024] [Indexed: 11/26/2024]
Abstract
Anorectal malformations (ARM) are rare congenital anomalies with an overall prevalence of 3.32 per 10,000 pregnancies. ARM describe a spectrum of anomalies of the anus and rectum ranging from a minimally displaced anal canal to a complete fusion of the anorectum, vagina and urethra with hypoplastic sphincter and pelvic floor muscle. Aberrant septation of the hindgut with anomalous cloacal membrane during weeks 6 to 9 of gestation form the developmental basis for a spectrum of anomalies defined as ARM. Although underlying specific syndromes and occasional familiar occurrence suggest genetic aetiology, most ARM are non-syndromic and their causal genetic mechanisms and non-genetic insults remain unclear. ARM is a clinical diagnosis, generally made early after birth via careful inspection of the perineum. Prenatal detection remains rare, and modern technical developments have added little to prenatal diagnostics. ARM is corrected surgically. Since its introduction in 1982, posterior sagittal anorectoplasty is the most common surgery for ARM reconstruction. Subsequent surgical adaptations focus on minimizing iatrogenic operative injury by limiting surgical invasiveness. They include laparoscopic procedures and shortening of incisions with confined dissection in open surgery. Although outcomes in patients with ARM have evolved throughout the past decades, there is urgent need for further improvements both in functional outcomes and quality of life. The importance of psychosocial experiences of affected patients is increasingly recognized. Continued research is necessary to improve prenatal detection, to elucidate genetic and epigenetic alterations and to refine optimal surgical procedures.
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Affiliation(s)
- Ivo de Blaauw
- Department of Surgery, Division of Paediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, the Netherlands.
| | - Pernilla Stenström
- Department of Paediatric Surgery, Institution of Clinical Sciences, Lund university, Skane University Hospital, Lund, Sweden
| | - Atsuyuki Yamataka
- Department of Paediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuichiro Miyake
- Department of Paediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Heiko Reutter
- Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Paola Midrio
- Paediatric Surgery Unit, Cà Foncello Hospital, Treviso, Italy
| | - Richard Wood
- Department of Paediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Caterina Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Mikko Pakarinen
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Wondemagegnehu BD, Asfaw SW, Mamo TN, Aklilu WK, Robelie AT, Gebru FT, Gebreselassie HG. Incidence of associated anomalies in children with anorectal malformation: A 1-year prospective observational study in a low-income setting. Medicine (Baltimore) 2024; 103:e39811. [PMID: 39312317 PMCID: PMC11419488 DOI: 10.1097/md.0000000000039811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 09/01/2024] [Indexed: 09/25/2024] Open
Abstract
Anorectal malformations (ARMs) consist of a range of anomalies that are often associated with other anomalies The purpose of the study is to assess the incidence of associated congenital anomalies that are seen in patients with ARMs. An observational prospective study was conducted on 162 cases with ARM from February 2019 to January 2020, and data were collected on patient demographics, type of ARM, and associated anomalies using a prestructured questionnaire and analysis done using SPSS (IBM), version 23, software. Relevant statistical analysis was done, and the results are presented in tables and charts. Of 162 cases studied, 70 of them were males and 92 were females with a male-to-female ratio of 0.76:1. The majority of male patients (45%) had rectourethral fistulas, whereas 63% of the females had rectovestibular fistula. While 76 (47%) patients presented with isolated ARM, 86 (53%) had ≥1 associated congenital malformations. Forty-eight (30%) patients presented with a single associated anomaly, whereas 20 (12%) patients had≥3 associated anomalies. The commonest associated anomalies were urologic 26.5% followed by genital (22.8%), cardiac 20.4%, and musculoskeletal 16.6%, and 12.3% of them had vertebral; anorectal; cardiac; tracheoesophageal fistula; renal; limb association. More than half of the children have other associated abnormalities. We found urogenital anomalies to be the most common associated congenital defects. A lower incidence of cardiac and spinal cord anomalies was noted suggesting a need for active workup to be in line with the latest standards of care.
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Affiliation(s)
- Belachew Dejene Wondemagegnehu
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Solomon Wubetu Asfaw
- Department of Surgery, Unit of Pediatric Surgery, College of Health Sciences, Jig Jiga University, Jig Jiga, Ethiopia
| | - Tihtina Nigussie Mamo
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Woubedel Kiflu Aklilu
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Amezene Tadess Robelie
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Fisseha Temesgen Gebru
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Hanna Getachew Gebreselassie
- Department of Surgery, Division of Pediatric Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
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Solomon S, Temesgen F, Tibebu S, Abebe H, Seyoum G. Anorectal Malformations (ARM) and associated maternal factors among children at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia: An unmatched case-control study. PLoS One 2024; 19:e0309298. [PMID: 39302955 DOI: 10.1371/journal.pone.0309298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/09/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Anorectal malformations (ARMs) are birth defects that affect the rectum, anus, and surrounding structures. While genetic and environmental factors may contribute to the risk of developing ARMs, the exact causes are largely unknown. Notably, there is a lack of research investigating predisposing factors for ARMs within the Ethiopian population, despite the burden of this condition in the country. OBJECTIVE The research study aimed at to examine the maternal risk factors linked to the occurrence of anorectal abnormalities in children receiving treatment at designated public hospitals located in Addis Ababa, Ethiopia. METHODS An unmatched case-control study was conducted at selected hospitals on mothers and their children between August 2022 and January 2023. The sample consisted of pediatric patients admitted to pediatric surgical units. Cases were diagnosed with ARMs, while controls had no congenital anomalies. Data was collected from the mothers of both cases and controls. The data was validated and then exported to SPSS version 26 for analysis. The analysis employed descriptive statistics and binary logistic regression. In a multivariable model, an adjusted odds ratio (AOR) together with a 95% confidence interval and p-value < 0.05 was used to determine significance. RESULT This study included 68 ARM cases and 136 controls. Multivariable analysis found that a family history of birth defects (AOR = 6.15, 95% CI: 1.24-30.58), maternal alcohol use (AOR = 4.71, 95% CI: 1.71-12.00), first-trimester medication use (AOR = 4.86, 95% CI: 1.29-18.32), advanced maternal age (AOR = 4.22, 95% CI: 1.21-14.69), and unplanned pregnancy (AOR = 3.701, 95% CI: 1.551-8.828) were significant risk factors for ARM. CONCLUSION The study found that key risk factors for ARM include family history of birth defects, maternal alcohol use, first-trimester medication use, advanced maternal age, and unplanned pregnancy. These findings underscore the importance of tailored prevention strategies and screening programs to address the genetic, maternal lifestyle, and maternal health factors that contribute to this congenital disorder.
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Affiliation(s)
- Samrawit Solomon
- Department of Anatomy, School of Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Fisseha Temesgen
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tibebu
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hana Abebe
- Department of Surgery, School of Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Girma Seyoum
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ambartsumyan L. Medical management of anorectal malformations. Aliment Pharmacol Ther 2024; 60 Suppl 1:S77-S84. [PMID: 38924569 DOI: 10.1111/apt.17897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/28/2023] [Accepted: 01/26/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Anorectal malformations (ARMs) are congenital anomalies of the anorectum and the genitourinary system that result in a broad spectrum of hindgut anomalies. Despite surgical correction patients continue to have late postoperative genitourinary and colorectal dysfunction that have significant impact on quality of life. AIM This paper will review the current evidence and discuss the evaluation and management of postoperative patients with ARMs who present with persistent defecation disorder. METHODS A literature search was conducted using PubMed/MEDLINE/EMBASE databases applying the following terms: ARMs, imperforate anus, constipation, faecal incontinence, neurogenic bowel, posterior sagittal anorectoplasty. RESULTS Patients who present with postoperative defecation disorders require timely diagnostic and surgical evaluation for anatomic abnormalities prior to initiation of bowel management. Goals of management are to avoid constipation in young children, achieve faecal continence in early childhood and facilitate independence in older children and adolescents. Treatment options vary from high dose stimulant laxatives to high-volume retrograde and antegrade enemas that facilitate mechanical colonic emptying. CONCLUSIONS Appropriate diagnostic work-up and implementation of treatment can decrease long-term morbidity and improve quality of life in postoperative patients with ARMs who presents with defecation disorders.
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Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Nutrition, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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Moras P, Zarfati A, Bagolan P, Conforti A, Toscano A, Iacobelli BD. Anorectal malformations (ARM) and VACTERL association and severity of congenital heart diseases (CHD): Experience of 396 consecutive patients in a tertiary center. Pediatr Neonatol 2024; 65:381-385. [PMID: 38163746 DOI: 10.1016/j.pedneo.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Congenital heart diseases (CHD) are the most frequently associated anomalies with anorectal malformations (ARM). Nevertheless, many specific aspects of CHD in ARM patients have yet to be studied. The aims of this study were to evaluate the prevalence and distribution of CHD in neonates-infants with ARM, and to explore whether the severity of ARM, and the presence of VACTERL association, had an impact on CHD rate, severity, and timing at first cardiac surgery. STUDY DESIGN All consecutive newborn-infants with ARM managed in our tertiary center (January-1999; December-2021) were collected from a prospective database and retrospectively analyzed. Prevalence and distribution of CHD in ARM patients were assessed. Patients were divided into groups depending on ARM severity and presence of VACTERL association. Pairwise comparison for CHD prevalence, severity, and timing at first cardiac surgery was performed between groups. RESULTS Of 396 ARM patients identified, those with severe ARM showed a higher number of overall CHD compared to patients with non-severe ARM (36.7 % vs. 25.2 %, p = 0.032). VACTERL + patients had a significantly higher prevalence of CHD (73.4 % vs. 16.4 %; p <0.001) and major CHD (51.7 % vs. 26.9 %; p = 0.008) when compared with VACTERL-patients. Furthermore, VACTERL + patients underwent first cardiac surgery at a significantly younger age than VACTERL-patients (5.2 ± 15.2 months vs. 11.9 ± 6.3, p = 0.039). CONCLUSIONS Patients with severe ARM had a higher number of CHD compared to patients with non-severe ARM. VATERL + patients had significantly more CHD and more severe CHD than VACTERL-patients. Early screening for CHD is strongly recommended in all newborns diagnosed with ARM before surgery. LEVEL OF EVIDENCE III retrospective comparative study.
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Affiliation(s)
- Patrizio Moras
- Perinatal Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelo Zarfati
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Pietro Bagolan
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Islam T, Nusrat F, Islam MK, Hossain M. Anorectal malformation diverted with transverse colostomy associated with recurrent urinary tract infections. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Wang D, Xu H, Liu K, Tou J, Jia Y, Gao W, Chen X, Luo F. Different Reaction Patterns of Caregivers of Children With Imperforate Anus: A Latent Profile Analysis. Front Pediatr 2021; 9:796725. [PMID: 35186823 PMCID: PMC8850696 DOI: 10.3389/fped.2021.796725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
AIM This study aimed to explore how different dimensions of caregivers' reaction shape their caring experience, and the factors associated with different reaction patterns. DESIGN A second analysis of a multisite cross-sectional study were conducted. Caregivers of children with imperforate anus (IA) were enrolled in three tertiary children's hospitals in Eastern China between November 2018 and February 2019. METHODS The caregiver's experience, stigma feeling, social support level and perception of uncertainty were assessed by Caregiver Reaction Assessment, Parent Stigma Scale, Social Support Scale and Parent's Perception of Uncertainty Scale accordingly. The demographic information of caregivers as well as the children's clinical data were collected. Latent profile analysis was conducted to determine different patterns of caregiver's reaction, and logistics analysis was used to explore the associated factors of the reaction pattern. FINDINGS A total number of 229 caregivers (median age = 30, quartiles: 28, 36) were included. Three distinguishable caregiving reaction types were identified (Class 1: low burden and high benefit, 4.8%; Class 2: moderate burden and benefit, 48.9%; Class 3: high burden and low benefit, 46.3%). In logistics analysis, the Class 1 and Class 2 were combined as one group due to the low population in Class 1. The marital status of caregiver (OR = 0.067, 95% CI: 0.006, 0.700, P = 0.024), IA type (OR = 1.745, 95% CI: 1.198, 2.541, P = 0.004), children aged > 2 years (OR = 3.219, 95% CI: 1.364, 7.597, P = 0.008), social support (OR = 0.907, 95% CI: 0.865, 0.951, P < 0.001) and perception of uncertainty (OR = 1.054, 95% CI: 1.026, 1.083, P < 0.001) were associated with different caregiver reaction patterns. CONCLUSION Nearly half of the caregivers of children with IA experience reaction of high burden and low benefit, but considerable proportion of caregivers could benefit from the caregiving rather than burden from. Married caregivers may have more negative reaction, especially when children > 2 years and diagnosed with intermediate or high type of IA. However, increasing caregiver's social support and reducing perception of uncertainty may have the potential to modify their reaction pattern.
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Affiliation(s)
- Dan Wang
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongzhen Xu
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kexian Liu
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinfa Tou
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yushuang Jia
- Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Gao
- Anhui Provincial Children's Hospital, Hefei, China
| | - Xiaofei Chen
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feixiang Luo
- Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Dessanti A, Louisma O, Pierre GS, Liem NT. Anorectal Malformation with Rectovestibular Fistula and Vaginal Agenesis: Usage of Rectovestibular Fistula as a Neovagina Followed by PSARP with Preservation of the Anal Sphincter. European J Pediatr Surg Rep 2021; 9:e51-e55. [PMID: 34277324 PMCID: PMC8276751 DOI: 10.1055/s-0041-1728725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Anorectal malformation with rectovestibular fistula associated with vaginal agenesis is rare. We report on a child in whom this combination was diagnosed at the age of 1 year. After creation of a divided descending colostomy, we chose to leave the rectum-rectovestibular fistula to function as a neovagina, while the sigmoid colon was relocated via modified posterior sagittal anorectoplasty. The colostomy was closed 6 months after the main surgery. After a follow-up of 3 years, the patient is continent for stool and urine. The introitus of the neovagina appears wide and easy to explore. We conclude that our surgical approach may be a good option for these children.
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Affiliation(s)
| | - Osnel Louisma
- Department of Pediatric Surgery, Saint Damien Children Hospital, Port Au Prince, Haiti
| | - Gabriel Steve Pierre
- Department of Pediatric Surgery, Saint Damien Children Hospital, Port Au Prince, Haiti
| | - Nguhien Thanh Liem
- Department of Pediatric Surgery, National Children Hospital and Vinmec International Hospital, Hanoi, Vietnam
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