Atresia of an anus and rectum

Description:

Atresia of an anus and rectum — lack of the natural channel of a rectum and/or an anal orifice; anomaly of development.

Frequency. 1:500–1:5000 live-born. The prevailing floor — men's (2:1).

Symptoms of the Atresia of an anus and rectum:

If the child after the birth for any reasons was not examined, then by the end of days the newborn begins to worry, there are a plentiful vomiting, vomiting stomach contents, then — bile, and in late terms — meconium, gradual abdominal distention. Meconium and gases do not depart. The picture of low intestinal impassability develops.

The physical research during the first hours after the birth establishes a type of an atresia and its height.
- The covered anus — the easiest form of a low atresia. On site an anal orifice reveal a translucent membrane which the rectum filled with meconium appears through
- Atresia of the proctal channel: also carry to the category of low. On site an anal orifice find insignificant impression of the pigmented site of skin. When pressing on it feel balloting (a low arrangement of a rectum)
- Atresia of the proctal channel and rectum: carry to high forms of atresias. The crotch is usually reduced in sizes, is underdeveloped. There is no tailbone, sometimes — a sacrum. On site anal orifice skin most often smooth
- The rectum atresia (isolated) can be high and low. The anal orifice with an eumorphic outside sphincter is located on the usual place. For establishment of the diagnosis it is enough to enter a catheter through an anal orifice or to conduct a manual research - Fistula in a reproductive system happens only at girls. The main sign — release of meconium, and then a calla and gases through a sexual crack
- Fistula in uric system (a bladder, an urethra) arises almost only at boys. The main sign — an otkhozhdeniye of meconium and gases through an outside opening of an urethra. At a fistula arrangement above a bladder sphincter meconium departs only during an urination (the urine painted by meconium)
- The Kloakalny form of an atresia — the most difficult anorectal malformation. During survey find lack of an anal orifice. On site, where there have to be outside openings of an urethra or vagina, there is one opening — an exit of a foul place in which open an urethra, a vagina and a rectum. Anatomic forms of a foul place are diverse therefore detailed inspection is necessary
- Fistula on a crotch arises at boys and girls. Diagnosis is based on external examination — an otkhozhdeniye of meconium and gases from "the atypical place"
- The combined malformations in various combinations (a kidney aplasia, a megaureter, a hypospadias, doubling of a kidney and an ureter, etc.) often arise at atresias of an anus and a rectum.

Reasons of the Atresia of an anus and rectum:

There are hereditary forms of atresias.
- Syndromes of VATER and VACTERL (192350): atresia of an anus, gullet, duodenal and direct guts, tracheosesophageal fistula, hypoplasia of lungs, dysplasia of a beam bone, shestipalost, femur hypoplasia, misplaced of a thumb of a brush, DMZhP, agenesia of kidneys, atresia of an urethra and hydronephrosis, defects of vertebrae (semi-vertebrae)
- Syndrome of VACTERL and hydrocephaly (314390, À or r). Combination of a syndrome of VACTERL and hydrocephaly
- A dysostosis pozvonkovo-costal with an atresia of an anus and urogenital anomalies (271520, r): an anus atresia, urinogenital anomalies, the only umbilical artery, the expressed dysplasia of edges and vertebrae, an unusual shape of a thorax.

Treatment of the Atresia of an anus and rectum:

Methods of surgical interventions:
- Single-step radical operation on a technique Foam
- At contraindications to single-step radical operation or at impossibility of its performance impose to kolosty.

Contraindications to single-step radical operation:
- Heavy combined malformations
- Associated diseases
- A high atresia of a rectum at the child with prematurity of the II-IV degree.