tailieunhanh - Ebook Surgical treatment of colorectal problems in children: Part 2

Part 2 book “Surgical treatment of colorectal problems in children” has contents: Rectal atresia, rectovestibular fistula, cloaca, posterior cloaca and absent penis spectrum, postoperative evaluation, operations for the administration of antegrade enemas, urologic problems in anorectal malformations, and other contents. | 14 Rectal Atresia Rectal atresia is a very unique malformation that deserves a special description. It happens in our experience, in about 1 % of all cases of anorectal malformations. In this defect, the anus seems to be completely normal, including the quality of the sphincter and the location of the anal orifice. However, deep inside the anus, just at the junction of the anal canal with the rectum, there is an atresia or narrowing (stenosis) (Fig. ). Occasionally, we see atresias or stenosis located at a different level. The space that separates the dilated blind rectum, from the anal canal, is represented by a septum that sometimes is extremely thin and can be perforated, and other times it is very thick. In some unusual cases, there is a significant separation between the blind upper rectum and the lower anal canal. a Interestingly, the sphincter mechanism is excellent in most cases. There is one particular malformation similar to this one that is represented by a stricture or by atresia of the rectum, associated to a presacral mass and a sacral defect (see Chap. 8, Sect. ), which is a completely different type of defect. The only thing they have in common is the fact that the rectum is narrow or atretic. We believe that rectal atresia with normal sacrum and no presacral mass is unique, because the sphincter mechanism is normal and also because these patients do not have the typical association with all the defects that we see in other anorectal malformations. As a consequence, the prognosis for these patients is excellent, in terms of bowel control. They have a b Fig. Rectal Atresia. (a) Diagram. (b) External appearance A. Peña, A. Bischoff, Surgical Treatment of Colorectal Problems in Children, DOI , © Springer International Publishing Switzerland 2015 201 14 Rectal Atresia 202 significant tendency to suffer from severe constipation because they are born with a blind, very dilated rectum. These malformations