Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_29
© Springer International Publishing Switzerland 2014
Imperforate Anus and Cloaca
(1)
Department of Pediatric Surgery, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
Imperforate anus is a condition affecting males and females, in which the anus fails to form in the correct location. There is wide variation in abnormality requiring individualization of treatment. Often imperforate anus is accompanied by other anomalies.
Imperforate anus is a condition affecting males and females, in which the anus fails to form in the correct location. There is wide variation in abnormality requiring individualization of treatment. Often imperforate anus is accompanied by other anomalies.
1.
Pathophysiology:
(a)
Epidemiology:
(i)
Incidence is one in 5,000 births.
(b)
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Classification
(i)
Male:
1.
Low lesions:
(a)
Anal stenosis (normal location, narrow diameter).
(b)
Ano-cutaneous fistula (a tiny channel which leaks small quantities of meconium) There may be a thin membrane which completely occludes the anal orifice.
(c)
Anterior ectopic anus: anus forms anterior to the normal location through the anal sphincter muscle complex, leading to dysfunction and constipation. When normally located, the anus should be halfway between the tip of the coccyx and the back of the scrotum.
2.
Intermediate:
(a)
Recto-bulbar urethral fistula.
3.
High:
(a)
Recto-prostatic urethral fistula.
(b)
Recto-vesicular fistula.
(c)
Anorectal atresia without fistula.
(ii)
Female:
1.
Low lesions:
(a)
Anal stenosis.
(b)
Ano-cutaneous fistula.
(c)
Anterior ectopic anus: anus forms anterior to the normal location through the anal sphincter muscle complex, leading to dysfunction and constipation. When normally located, the anus should be halfway between the tip of the coccyx and the posterior fornix of the vagina.
(d)
Ano-vestibular fistula.
2.
Intermediate:
(a)
Recto-vestibular fistula.
(b)
Recto-lower vaginal fistula.
3.
High:
(a)
Recto-upper vaginal fistula.
(b)
Anorectal atresia without fistula.
(iii)
Persistent cloaca: occurs in females, when the urethra, vagina, and rectum all join to form one channel called the persistent cloaca, a term which means “gutter”. The vagina can be distended as a hydrocolpos which can compress the trigone of the bladder and cause urinary obstruction. Persistent cloaca can be classified by length of the common channel: longer than 3 cm is considered a long common channel.
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