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Congenital rectovesical fistula and its associated anomalies
454
ABSTRACTS
A simplified portable anomanometer has been devised, consisting of a single balloon probe, transducer, and meter, and has proved useful (1) in quantitatively assessing continence after surgery for anorectal malformation and (2) in diagnosing Hirschsprung’s disease. Those children following surgery for anorectal malformation with a resting tone of 20 mm Hg and a voluntary squeeze
pressure
of 30 mm Hg or more
had
an excellent state of continence, whereas the combination of a resting tone below 15 mm Hg and a voluntary squeeze less than 30 mm Hg had unacceptable incontinence. Borderline cases falling between these two groups improved with special diet, education, or the lapse of time. The normal response to rectal distension is a positive wave caused by voluntary sphincter contraction, followed by a negative wave due to relaxation of the invoiuntary sphincter. In Hirschsprung’s disease the negative wave is absent and the manometer
was
found
useful
in screening
babies
and children with bowel dysfunction and subjecting those with abnormal findings to confirmatory rectal biopsy. The anomanometer was also usefuul as a check where doubts arise as to the adequacy of the biopsy and in cases of ultrashort aganglionic segments. The authors outline some of the pitfalls in the use of this instrument, especially in the newborn.-7. R. Solomon Congenital Rectovesical Fistula and Its Associated Anomalies. Ruth V. Magnus. Aust. New Zeal. J. Surg. 42:197-204 (November), 1972. Eleven autopsy specimens of the rare congenital rectovesical fistula (approximately 2% of anorectal malformations) were studied from children who usually are stillborn or die soon after birth from malformations incompatible with life. The fistula entered the posterior wall of the bladder either low (close to the internal urinary meatus) or high and the epithelium and muscle coverings are described. Seven of the specimens (six from males) had complete urethral obstruction and four (one from a male) had patent urethras: but of the total, only four exhibited renal tissue compatible with life and two of these would require relief of urethral obstruction. The vertebral column was deficient in those
specimens with a high rectovesical fistula. Four of five specimens available with the pelvis intact exhibited a contracted pelvic outlet. The pelvic floor in some specimens was deficient due to deficient nerve supply or bony deflection.-7. R. Solomon Clinical Aspects High Anorectal Robert
of Female Patients With Agenesis. Morton Pa/ken,
J. Johnson,
and
Surg. Gynec. Obstet: tember), 1972.
Walter
135:411-416
Derrick.
(Sep-
The authors report ten female patients with high anorectal anomalies. One patient did not have a rectal fistula. The remaining nine were found to have the opening from the urethra or neck of the bladder, if no urethra was present, located opposite to the rectal orifice as each entered a single tubular structure at approximately the same level with the vaginal aperture just above and between them. The tubular structure is presumed to be the residual of the embryologic urogenital sinus. The authors report that if only one genitourinary opening is visible with no anal opening, one must expect a high rectocloacal deformity. When the urethral meatus and hymen are visible, the rectal opening will usually be found low and into the posterior portion of the vulva. The plan of management suggested by the author consists of an initial sigmoid colostomy followed by appropriate delayed rectal reconstruction. For the urinary tract, the urogenital sinus must be kept dilated to allow free drainage of urine from the bladder and vagina. Urethral dilatations may also be necessary. The upper part of the genitourinary tract must be evaluated within the first month of life and approuriate measures taken for any obstruction found. In some instances it may be necessary to reconstruct the vagina after definitive care of the rectum and urinary tract has been accomplished.-George Holcomb. ABDOMEN Twins With Congenital dominal Musculature. Fish% and A. S. Cass.
(April),
Deficiency of AbD. S. Petersen, L. J. Ural. 107:670-672
1972.
This case report describes with prune-belly syndrome.
twin males One of the
ABSTRACTS
A simplified portable anomanometer has been devised, consisting of a single balloon probe, transducer, and meter, and has proved useful (1) in quantitatively assessing continence after surgery for anorectal malformation and (2) in diagnosing Hirschsprung’s disease. Those children following surgery for anorectal malformation with a resting tone of 20 mm Hg and a voluntary squeeze
pressure
of 30 mm Hg or more
had
an excellent state of continence, whereas the combination of a resting tone below 15 mm Hg and a voluntary squeeze less than 30 mm Hg had unacceptable incontinence. Borderline cases falling between these two groups improved with special diet, education, or the lapse of time. The normal response to rectal distension is a positive wave caused by voluntary sphincter contraction, followed by a negative wave due to relaxation of the invoiuntary sphincter. In Hirschsprung’s disease the negative wave is absent and the manometer
was
found
useful
in screening
babies
and children with bowel dysfunction and subjecting those with abnormal findings to confirmatory rectal biopsy. The anomanometer was also usefuul as a check where doubts arise as to the adequacy of the biopsy and in cases of ultrashort aganglionic segments. The authors outline some of the pitfalls in the use of this instrument, especially in the newborn.-7. R. Solomon Congenital Rectovesical Fistula and Its Associated Anomalies. Ruth V. Magnus. Aust. New Zeal. J. Surg. 42:197-204 (November), 1972. Eleven autopsy specimens of the rare congenital rectovesical fistula (approximately 2% of anorectal malformations) were studied from children who usually are stillborn or die soon after birth from malformations incompatible with life. The fistula entered the posterior wall of the bladder either low (close to the internal urinary meatus) or high and the epithelium and muscle coverings are described. Seven of the specimens (six from males) had complete urethral obstruction and four (one from a male) had patent urethras: but of the total, only four exhibited renal tissue compatible with life and two of these would require relief of urethral obstruction. The vertebral column was deficient in those
specimens with a high rectovesical fistula. Four of five specimens available with the pelvis intact exhibited a contracted pelvic outlet. The pelvic floor in some specimens was deficient due to deficient nerve supply or bony deflection.-7. R. Solomon Clinical Aspects High Anorectal Robert
of Female Patients With Agenesis. Morton Pa/ken,
J. Johnson,
and
Surg. Gynec. Obstet: tember), 1972.
Walter
135:411-416
Derrick.
(Sep-
The authors report ten female patients with high anorectal anomalies. One patient did not have a rectal fistula. The remaining nine were found to have the opening from the urethra or neck of the bladder, if no urethra was present, located opposite to the rectal orifice as each entered a single tubular structure at approximately the same level with the vaginal aperture just above and between them. The tubular structure is presumed to be the residual of the embryologic urogenital sinus. The authors report that if only one genitourinary opening is visible with no anal opening, one must expect a high rectocloacal deformity. When the urethral meatus and hymen are visible, the rectal opening will usually be found low and into the posterior portion of the vulva. The plan of management suggested by the author consists of an initial sigmoid colostomy followed by appropriate delayed rectal reconstruction. For the urinary tract, the urogenital sinus must be kept dilated to allow free drainage of urine from the bladder and vagina. Urethral dilatations may also be necessary. The upper part of the genitourinary tract must be evaluated within the first month of life and approuriate measures taken for any obstruction found. In some instances it may be necessary to reconstruct the vagina after definitive care of the rectum and urinary tract has been accomplished.-George Holcomb. ABDOMEN Twins With Congenital dominal Musculature. Fish% and A. S. Cass.
(April),
Deficiency of AbD. S. Petersen, L. J. Ural. 107:670-672
1972.
This case report describes with prune-belly syndrome.
twin males One of the