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Sonographic detection and localization of fistulas in fetuses with imperforate anus: Case reports
Takashi Kaji1, Kazuhisa Maeda2, Eishi Sogawa1
1Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Insights
Prenatal diagnosis of imperforate anus (IA) fistulas is possible using specific ultrasound views. This early detection aids in planning crucial neonatal surgical treatment for congenital abnormalities.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Fetal Medicine
Background:
- Imperforate anus (IA) is a congenital condition requiring prompt neonatal surgical intervention.
- IA is frequently associated with fistulas, whose location dictates treatment strategy.
- Accurate prenatal assessment of fistula location is critical for managing complex cases.
Observation:
- This study reports three cases of imperforate anus (IA) with prenatally detected and localized fistulas.
- High-frequency ultrasound, particularly sagittal views (infracoccygeal or perineal approach), enabled precise visualization of fetal pelvic anatomy and fistula location.
- Neonatal examinations confirmed the prenatal findings.
Findings:
- The sagittal view using fetal infracoccygeal or perineal approaches with high-frequency transducers is effective for prenatal fistula localization in IA.
- Prenatal identification of fistula anatomy is feasible and accurate.
Implications:
- This technique can improve surgical planning and outcomes for neonates with imperforate anus and associated fistulas.
- Early prenatal diagnosis facilitates timely multidisciplinary care coordination.
- Enhanced prenatal imaging may reduce the need for extensive postnatal investigations.
Abstract:
Imperforate anus (IA) requires urgent treatment after birth, which is dependent on the type of IA, and is also frequently associated with other congenital abnormalities. Most patients with IA have an accompanying fistula, whose location is strongly associated with the type of IA. The fistula location can be a key factor in defining appropriate treatment, especially in neonates presenting with severe associated abnormalities. Herein, we report three cases of IA in which fistulas were detected and localized prenatally. Examination of the fetal pelvis through the sagittal or coronal view, using high-frequency transducers, revealed the location of the fistulas. In particular, the sagittal view obtained using the fetal infracoccygeal or perineal approach allowed us to determine the precise anatomy of the fistulas. Neonatal assessment confirmed the fistula locations. We recommend using the sagittal view obtained using the fetal infracoccygeal or perineal approach with high-frequency transducers to assess fistulas in fetuses with IA.
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