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Year 2010 Vol. 18 No 6

LECTURES, REVIEWS

LEVIN M.D., TROYAN V.V.

PATHOLOGICAL PHYSIOLOGY, DIAGNOSTICS AND PROSPECTS FOR TREATMENT OF THE LOW IMPERFORATE ANUS IN NEWBORNS

Despite enormous interest in the development of an ideal operation procedure to treat congenital anorectal malformations, the situation is as confusing today as it was 30 years ago. The soling or chronic constipation is observed in one third of all postoperative patients, most frequently after the correction of the high or intermediate anomalies. It was shown that anal canal in newborns with low imperforate anus is always normally formed up to the distal 3-5 mm, i.e. at the level of the skin and subcutaneous tissue of the perineum. Closed anal canal does not have any volume and it is not seen in the invertogram. The original method of X-Ray diagnosis of anorectal anomalies makes it possible to discover the anal canal if it exists. Operational findings can not be taken as a criterion for the correct diagnosis because rectal pressure decreases under the influence of anesthetics and the anal canal remains closed. A surgeon bypasses it and takes out the rectum instead. As a result, the muscles and neural connections of the anal canal and rectum are impaired. Then, patient is falsely diagnosed with high or intermediate imperforate anus which «justifies» the unsatisfactory functional results. Two methods of the operation are discussed here. They allow to utilize all elements of the anal canal that take part in the continence and defecation.

Keywords: imperforate anus, low anorectal anomalies, rectal atresia, newborn, bowel perforation, X-Ray diagnosis, invertogram, operation
p. 105 – 114 of the original issue
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