Clinicopathological evaluation of the terminal end of the distal rectal pouch and fistula site in anorectal malformation

Renu Kushwaha; Santosh Kushwaha; Nirbhay Singh; Rakesh Saxena; Shaila Mitra; Sujeet Kumar Mathur

doi:10.18203/2349-2902.isj20242761

Authors

Renu Kushwaha Department of General Surgery, BRD Medical College, Gorakhpur, UP, India
Santosh Kushwaha Department of General Surgery, BRD Medical College, Gorakhpur, UP, India
Nirbhay Singh Department of Neurosurgery, RML Institute of Medical Science, Lucknow, UP, India
Rakesh Saxena Department of General Surgery, BRD Medical College, Gorakhpur, UP, India
Shaila Mitra Department of Pathology, BRD Medical College, Gorakhpur, UP, India
Sujeet Kumar Mathur Department of General Surgery, ASMC Kushinagar, UP, India

DOI:

https://doi.org/10.18203/2349-2902.isj20242761

Keywords:

Distal rectal pouch, ARM, Fistula site

Abstract

Background: The aim is to assess the clinicopathological evaluation of the terminal end of the distal rectal pouch and fistula site in anorectal malformation (ARM).

Methods: This study was conducted on patients who attended the surgery OPD and included 40 cases of ARMs over a 12-month period. All cases were admitted to the department of surgery at B. R. D. medical college, Gorakhpur, UP.

Results: Out of 40 cases studied 22 cases (55%) were female and 18 cases (45%). Out of total 40 cases, recto-bulbourethral fistula shown by 8 male patient (20%), recto-prostatic fistula shown by 8 male patient (20%), and recto-bladder neck fistula shown by 2 male patient (5%) out of total 18 male patient (45%) of total cases. Recto-vestibular fistula shown by 7 female patient (17.5%), ano-vestibular fistula by 11 male patient (27.5%), low rectovaginal fistula shown 3 female patient (7.5%), and no fistula shown by 1 female patient (2.5%) out of total 22 female patient (55%). In our study wound infection (5 cases) 12.5%, excoriation (5 cases) 12.5 %, constipation and bleeding (2 case) 5% were noted, no complication seen in 65% cases. All of them were treated conservatively followed by anal dilatation.

Conclusions: Histopathological variations in the distal rectal pouch and fistula site of ARMs have led to differing opinions on whether to preserve or excise the fistula site. Our study found that 45% of patients had a smooth muscle layer present in the histopathological examination.

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References

Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Diseases. 2007;2(1):1-3.

Stephens FD, Smith ED. Ano-rectal malformations in children. Chicago; Year Book Medical. 1971.

Forrester MB, Merz RD. Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986-2002. J Toxicol Environ Health A. 2007;70:7-18.

Louw JH, Cywes S, Cremin BJ. Anorectal malformation: classification and clinical features. S Afr J Surg 1971;9(1):11-20.

Van der Putte SC. Anal and ano-urogenital malformations: a histopathological study of “imperforate anus” with a reconstruction of the pathogenesis. Pediatr Dev Pathol. 2006;9(4):280-96.

Van der Putte SCJ. Normal and abnormal development of the anorectum. J Pediatr Surg. 1986;21(5):434-40.

Frenckner B. Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia. Z Kinderchir. 1985;40(5):312-4.

Penninckx F, Kerremans R. Internal sphincter-saving in imperforate anus with or without fistula. A manometric study. Int J Colorectal Dis. 1986;1(1):28-32.

Lambrecht W, Lierse W. The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs. J Pediatr Surg. 1987;22(12):1160-8.

Vanderwinden JM. Role of interstitial cells of Cajal and their relationship with the enteric nervous system. Eur J Morphol. 1999;37(4-5):250-6.

Zwink N, Jenetzky E, Brenner H. Parental risk factors and anorectal malformations: systematic review and meta-analysis. Orphanet J Rare Dis. 2011:6:25.

Faussone-Pellegrini MS, Fociani P, Buffa R, Basilisco G. Loos of interstitial cells and a fibromuscular layer on the luminal side of the colonic circular muscle presenting as megacolon in an adult patient. Gut 1999;45(5):775-9.

Faussone-Pellegrini MS. Comparative study of interstitial cells of Cajal. Acta Anat. 1987;130(2):109-26.

Holschneider AM, Pfrommer W, Gerresheim B. Results in the treatment of anorectal malformation with special regard to the histology of the rectal pouch. Eur J Pediatr Surg. 1994;4(5):303-9.

Pena A, Hong A. Advances in the management of anorectal malformations. Am J Surg. 2000;180:370-6.

Pena A. Anorectal Malformations. Semin Pediatr Surg. 1995;4:35-47.

Pena A. Atlas of Surgical Management of Anorectal Malformations. New York: Springer-Verlag. 1990;49-55.

Rintala RJ. Fecal incontinence in anorectal malformations, neuropathy, and miscellaneous conditions. Seminar Pediatr Surg. 2002;11(2):75-82.

DeVries PA, Peña A. Posterior sagittal anorectoplasty. J Pediatr Surg. 1982;17(5):638-43.

Frenckner B. Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia. Zeitschrift für Kinderchirurgie. 1985;40(5):312-4.

Penninckx F, Kerremans R. Internal sphincter-saving in imperforate anus with or without fistula: A manometric study. Int J Colorectal Disease. 1986;1(1):28-32.

Lambrecht W, Lierse W. The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs. J Pediatr Surg. 1987;22(12):1160-8.

Faussone-Pellegri M, Fociani P, Buffa R, Basilisco G. Loss of interstitial cells and a fibromuscular layer on the luminal side of the colonic circular muscle presenting as megacolon in an adult patient. Gut. 1999;45(5):775.

Faussone-Pellegrini MS. Comparative study of interstitial cells of Cajal. Acta Anat. 1987;130:109-35.

Ong NT, Beasley SW. Long-term continence in patients with high and intermediate anorectal anomalies treated by sacroperineal (Stephens) rectoplasty. J Pediatr Surg. 1991;26(1):44-8.

Van der Putte SC. Anal and ano-urogenital malformations: a histopathological study of “imperforate anus” with a reconstruction of the pathogenesis. Pediatr Developmental Pathol. 2006;9(4):280-96.

Rintala R, Lindahl H, Sariola H, Rapola J, Louhimo I. The rectourogenital connection in anorectal malformations is an ectopic anal canal. J Pediatr Surg. 1990;25(6):665-8.

Meier-Ruge WA, Holschneider AM. Histopathologic observations of anorectal abnormalities in anal atresia. Pediatr surg Int. 2000;16:2-7.

Lombardi L, Bruder E, Caravaggi F, Carmine DR, Giuseppe M. Abnormalities in “low” anorectal malformations (ARMs) and functional results resecting the distal 3 cm. J Pediatr Surg. 2013;48:1294-300.

Holschneider AM, Ure BM, Pfrommer W, et al. Innervation patterns of the rectal pouch and fistula in anorectal malformations: a preliminary report. J Pediatr Surg. 1996;31:357-62

Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg. 2008;31(4):211-5.

Frenckner B. Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia. Z Kinderchir. 1985;40(5):312-4.

Hamid CH, Holland AJ, Martin HC. Long-term outcome of anorectal malformations: the patient perspective. Pediatr Surg Int 2007;23(2):97-102.

Gangopadhyaya AN and Pandey V. Anorectal Malformations. J Indian Assos Pediatr Surg. 2015;20(1):10-5.

Tiwari A, Naik DC, Khanwalkar PG, Sutrakar SK. Histological study of neonatal bowel in anorectal malformations. Int J Anat Res. 2014;2:318-24.

Agarwal K, Chadha R, Ahluwalia C, Debnath PR, Sharma A, Roy Choudhury S. The histopathology of congenital pouch colon associated with anorectal agenesis. Eur J Pediatr Surg. 2005;15(2):102-6.

Bhatia Y, Singh S, Kamal NR, Padam P, Divya S, Rajeev S. Anorectal Malformations: Histomorphological and Immunohistochemical Evaluation of Neuronal Dysfunction. J Neonatal Surg. 2017;6(2):29.

Holschneider AM, Koebke J, Meier-Ruge W. Pathophysiology of chronic constipation in anorectal malformations. Long-term results and preliminary anatomical investigations. Eur J Pediatr Surg 2001;11(5):305-10.

Martucciello G, Torre M, Prato AP, Lerone M, Campus R, Leggio S, et al. Associated anomalies in intestinal neuronal dysplasia. J Pediatr Surg 2002;37(2):219-23.

Meier-Ruge WA, Holschneider AM. Histopathologic observations of anorectal abnormalities in anal atresia. Pediatr Surg Int. 2000;16(1-2):2-7.

Gans SI, Friedman N. Some new concepts in the embryology, anatomy, physiology and surgical correction of imperforate anus. West J Surg Obstet Gynaecol. 1961;69:34-7.

Yokoyama J, Hayashi A, Ikawa H, Hagane K, Sanbonmatsu T, Endo M, et al. Abdomino-extended sacroperineal approach in high-type anorectal malformation and a new operative method. Z Kinderchir. 1985;40(3):150-7.

Meier-Ruge WA, Holschneider AM. Histopathologic observations of anorectal abnormalities in anal atresia. Pediatr Surg Int. 2000;16:2-7.

Lombardi L, Bruder E, Caravaggi F, Carmine DR, Giuseppe Ml. Abnormalities in “low” anorectal malformations (ARMs) and functional results resecting the distal 3 cm. J Pediatr Surg. 2013;48(6):1294-300.

Holschneider AM, Ure BM, Pfrommer W, Meier-Ruge W. Innervation patterns of the rectal pouch and fistula in anorectal malformations: a preliminary report. J Pediatr Surg. 1996;31(3):357-62

Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg. 2008;31(4):211-5.

Frenckner B. Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia. Z Kinderchir. 1985;40(5):312-4.