يافته هاي مادرزادي با ناهنجاريهاي مقعد و راست روده

Congenital Manifestations Associated with Anorectal Malformations

Introduction: ARMs and associated abnormalities (A. A.) are one of the most problematic and common entities in pediatric. Surgery A. A. recognition for optimal treatment and best recovery and prevention of disability is very important. About 50% of patient with high type and 25% of low type ARM have associated anomalies, some body single and the others multiple combined anomalies (anomalies in urogenital, musculoskeletal, gastrointestinal, cardiovascular and ophthalmic systems). Among these anomalies, sacral anomaly is very important because has direct effect on the function of urogenital and gastrointestinal system. Recognition of incidence of A. A. can help the physician to choose the best diagnostic and treatment modalities. This descriptive study in 64 patients with ARMs that have been operated at the pediatric surgery ward, Mashhad University, Medical School from 1995-1998 and followed for 4-7 years. Result: With regard to the results of physical examination, abdominal and chest X-Ray, ultrasonography, Echocardiography and Spinal cord studies (MRI, C.T Scan...), voiding cystourethrogram (VCUG), Intra venouspyeloureterography (I.V.U), distal colostogram, and Barium enema, 32 patients (50%) had associated anomalies (follow up period 4 to 7 years) Of 64 patients in this study; 32 cases (50%) had associated anomalies, mostly of urogenital system (31.2%). The prevalence of other associated anomalies were as bellow: Musculoskeletal system (18.6%), Gastro- intestinal tract (14%), Cardio- vascular system (6.2%), Opthalmic system (6.2%), Soft tissue (3%), Skull (3%), Right lung agenesis (1.5%). This studied the frequency of sex and type of 1.A in our cases. 62.5% were male, 37.5% female and had, 70.3% high type and 23.4% low type I.A, 6.25% cloacal type. Conclusion: All newborns should evaluate for normal anus, if has I.A., carefUl assessment of the genital tracts in females and the genitourinary system in all patients is imperative many children with a high I.A. have associated spinal cord anomalies, particularly tethered cord. Therefor should be better to evaluate with spinal U.S. & MRI. These infants require evaluations for signs of the VACTERL association including careful cardiac assessment. For these patients Urine analysis (U/A) chest X-Ray, ultrasonography, VCUG, Echocardiography, careful follow up is mandatory.