Fig. 30.1
A lateral photograph of a barium enema showing congenital rectal stenosis marked by arrows
Gupta and Sharma classified congenital rectal atresia into five types:
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Type I: Rectal stenosis
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Type II: Rectal atresia with a septal defect
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Type III: Rectal atresia with a fibrous cord between the two atretic ends
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Type IV: Rectal atresia with a gap
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Type V: Multiple rectal atresia with stenosis (A) or without stenosis (B)
Clinical Features
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Congenital rectal atresia in contrast to anorectal malformations is characterized by:
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A normal-looking anus.
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The anal canal and lower rectum are surrounded by a normally developed sphincter and hence a good functional postoperative outcome is expected.
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Unlike other anorectal malformations , congenital rectal atresia usually has no associated fistula communication with the urogenital system.
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Congenital rectal atresia commonly is an isolated malformation and without any other additional congenital anomalies.
Diagnosis
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The diagnosis of congenital rectal atresia is clinical.
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Patients usually present in the neonatal period with failure to pass meconium and abdominal distension (Fig. 30.2).
Fig. 30.2Clinical photograph showing abdominal distension and a normal-looking anus in a patient with congenital rectal atresia -
Clinically, there is a normal-looking anus.
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Failure to pass a thermometer confirms the diagnosis.
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Abdominal X-ray shows dilated bowel loops with no gas distally and an invertogram shows stoppage of the air in the distal rectum (Fig. 30.3).
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