Risk factors associated with anorectal malformations development. A case-control study

Anorectal Malformation Fistula Evaluation May Aid in Hirschsprung Diagnosis

INTRODUCTION

Concurrence of Hirschsprung disease (HD) and anorectal malformation (ARM) is rare, but early diagnosis is important for proper management. The aim of this study was to define the expected histological findings of rectal fistulae in ARM and to identify findings that may raise suspicion for concurrent HD.

METHODS

Eighty-six patients with ARM from a single institution were studied. Pathology reports as well as randomly selected fistula specimens were evaluated for the presence of ganglion cells at a single institution. An additional query of the Pediatric Colorectal and Pelvic Learning Consortium database was performed to examine clinical features of patients with HD and ARM.

RESULTS

Patients represented the spectrum of ARM, with perineal fistula being the most common. Ganglion cells were present in 78 of 86 (91%) specimens, hypoganglionosis in 5 of 86 specimens (6%), and absent in 3 of 86 (4%) specimens. Of the patients with absence of ganglion cells in their fistula specimens, 2 of 3 (66%) also carried a diagnosis of Trisomy 21. Within the Pediatric Colorectal and Pelvic Learning Consortium database, we identified 12 patients with both ARM and HD out of 1726 ARM subjects (0.7% of ARM patients). Among this group of patients, 33% (n = 4) had chromosomal anomalies.

CONCLUSIONS

The majority of fistula specimens from patients with ARMs contain ganglion cells. Absence of ganglion cells in patients with ARM should prompt suspicion for HD. This association may be more common in patients with chromosomal anomalies.

Anorectal malformations

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.

Faecal incontinence-a comprehensive review

Introduction

Faecal incontinence (FI) is a distressing and often stigmatizing condition characterised as the recurrent involuntary passage of liquid or solid faeces. The reported prevalence of FI exhibits considerable variation, ranging from 7 to 15% in the general population, with higher rates reported among older adults and women. This review explores the pathophysiology mechanisms, the diagnostic modalities and the efficiency of treatment options up to date.

Methods

A review of the literature was conducted to identify the pathophysiological pathways, investigation and treatment modalities.

Result and discussion

This review provides an in-depth exploration of the intricate physiological processes that maintain continence in humans. It then guides the reader through a detailed examination of diagnostic procedures and a thorough analysis of the available treatment choices, including their associated success rates. This review is an ideal resource for individuals with a general medical background and colorectal surgeons who lack specialized knowledge in pelvic floor disorders, as it offers a comprehensive understanding of the mechanisms, diagnosis, and treatment of faecal incontinence (FI).