Anorectal junction stenosis: diagnosis and management

The aim of this paper is to describe the management of 9 patients with anorectal junction stenosis and present the diagnostic features together with a single-stage surgical technique with reproducible results.

Nine patients with anorectal junction stenosis were seen over a period of 12 years. The children (aged from 2 months to 15 years) presented with constipation . Anorectal junction stenosis was diagnosed by rectal examination during which the tip of the finger was unable to pass beyond the stenosis in all cases. Contrast study showed the dilated rectosigmoid proximal to the stenosis.

Six patients (who did not have significant rectal dilation) underwent single-stage surgery by posterior Y-V plasty which was curative. Two patients were operated through the posterior sagittal route with a covering colostomy done during the same session; the oldest child required resection of the megasigmoid with abdominoperineal pull-through. None of the six patients operated with Y-V plasty experienced any complications. One of the patients operated via the posterior sagittal route had a leak from the anorectal anastomosis requiring revision. The follow-up ranged from 6 months to 12 years. All patients are alive and well and there was no recurrence of stenosis in any case.

Anorectal junction stenosis is a rare anorectal anomaly easily diagnosed by digital rectal examination. Single-stage surgery by posterior Y-V plasty is effective in curing the majority of these patients if significant rectosigmoid dilation is not present.