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[Computed tomography and anorectal malformations. Their preoperative evaluation].

A Taccone1, P Fondelli, G Martucciello

  • 1Servizio di Radiologia, Diagnostica per Immagini, Istituto G. Gaslini, Genova Quarto.

La Radiologia Medica
|April 1, 1989
PubMed
Summary

Preoperative pelvic CT scans help evaluate muscle development in children with anorectal malformations. This imaging aids in predicting the potential for continence after surgical treatment.

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Hirschsprung's disease, one of the most difficult diagnoses in pediatric surgery: a review of the problems from clinical practice to the bench.

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Area of Science:

  • Pediatric Surgery
  • Radiology
  • Anorectal Malformations

Background:

  • Anorectal malformations (ARMs) require precise anatomical understanding for surgical success.
  • Continence is a critical long-term outcome in ARM treatment.
  • Surgical approaches, like Peña's technique, rely on detailed anatomical knowledge.

Purpose of the Study:

  • To evaluate the utility of preoperative pelvic computed tomography (CT) in assessing sphincteric muscle development in pediatric patients with anorectal anomalies.
  • To correlate CT findings with surgical outcomes and prognostic potential for continence.

Main Methods:

  • Seven pediatric patients (1-30 months) with various anorectal anomalies underwent preoperative pelvic CT.
  • CT scans were analyzed to identify and grade the development of pelvic sphincteric muscles.

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  • Findings were compared with intraoperative observations.

    • Main Results:

    • CT demonstrated well-developed sphincteric muscles in 3 patients (rectoureteral, rectovestibular fistulas).
    • Poorly developed muscles were observed in 3 patients (rectovaginal, cloacal, prostatic fistulas).
    • Absence of musculature was noted in 1 patient (rectovesical fistula); CT missed thin musculature in this case.

    Conclusions:

    • Preoperative pelvic CT is a valuable tool for assessing sphincteric muscle development in anorectal malformations.
    • CT findings, alongside clinical and radiological data, aid in the prognostic evaluation of continence.
    • While generally accurate, CT may underestimate thin musculature in specific complex cases like rectovesical fistulas.