[Axial computed tomography in anorectal malformations: a pre- and postoperative indication?]

Area of Science:

• Pediatric Surgery
• Radiology
• Gastroenterology

Background:

• Anorectal malformations (ARMs) present complex challenges in pediatric surgery.
• Assessing potential for fecal continence preoperatively is crucial for surgical planning.
• Evaluating postoperative outcomes and identifying candidates for revision surgery is essential.

Purpose of the Study:

• To evaluate the utility of computed tomography (CT) in assessing sphincteric structures in patients with ARM.
• To correlate preoperative CT findings with postoperative continence.
• To determine the role of postoperative CT in identifying patients requiring secondary procedures for fecal incontinence.

Main Methods:

• Preoperative and postoperative pelvic CT scans were performed on patients with ARM.
• Sphincteric muscular structures (puborectal sling, levator ani, striated complex, external sphincter) were analyzed.
• Correlation between CT findings, surgical repair (including primary repair and secondary PSARP), and fecal continence was assessed.

Main Results:

• Preoperative CT identified well-developed sphincteric structures in 6/10 patients, poorly developed in 3/10, and absent in 1/10.
• Postoperative CT in 11 patients showed 2/11 with good sphincteric control; 9/11 were incontinent.
• Incontinent patients had hypoplastic sphincters or colon pulled through outside sphincteric structures; 2 were selected for secondary PSARP, with 1 achieving complete continence.

Conclusions:

• Pelvic CT is valuable for preoperative prognostic evaluation of continence in ARM.
• Postoperative CT is essential for selecting incontinent patients who may benefit from secondary PSARP.
• CT imaging aids in understanding the anatomical basis of incontinence and guiding further surgical management in ARM.