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A thorough understanding of each patient’s anatomy prior to treatment is necessary to ensure the correct treatment approach. The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies. Plain radiographs can show spinal anomalies such as spina bifida and spinal hemivertebrae and sacral anomalies such as a hemisacrum and sacral hemivertebrae. A spinal ultrasound in a newborn can identify evidence of a tethered spinal cord and other spinal anomalies. A crosstable lateral radiograph can help show the air column in the distal rectum in a small percentage of patients to identify the likely anorectal anomaly. Proper diagnostic testing not only identifies appropriate channels of treatment, but may also indicate the expected long-term outcomes of the patient.
Before the repair of an anorectal malformation, distal colostograms are performed and considered the most valuable and accurate diagnostic study because it enables the precise location of the fistula, outlining the technicalities of the surgery that will be needed.
Contrast enemas are valuable tools to not only identify continence issues among colorectal patients, but are often used in the bowel management program, as well, in order to help control incontinence.
There are several reasons why doctors recommend that children have a contrast enema — a procedure that uses air contrasted with another substance to better visualize the inside of the colon. When polyps, tumors, or other irregularities in the colon are suspected, a double contrast enema, using a dilute suspension of barium and air in a colon that has been thoroughly cleaned, can reveal if these irregularities are present in the colon. In most cases, however, contrast enemas in children are ordered because of problems of constipation.For patients with constipation due to poorly functioning nerves and muscles within their colons, contrast enemas are very valuable to help determine the extent of the problem and plan for treatment. We emphasize that when patients receive contrast enemas for these purposes, the colon should not be cleaned prior to the contrast enema study since we want to learn about the degree of constipation and fecal impaction the patient experiences. We also want to know how the patient empties the colon after the study. It is our policy that for these purposes, a contrast enema test never be done with barium, since barium provokes very severe impaction. The barium becomes petrified in the colon and often the patient has to be taken to the operating room to remove the impaction.
Read an in-depth description of contrast enema
Once the surgical emergency has been solved using a diverting colostomy, a patient with an anorectal malformation can be managed as a normal baby, unless other associated defects are present.Prior to the final repair, it is highly desirable to determine the precise type of anatomic defect, as it has important prognostic and therapeutic implications. For this, we have found the high-pressure distal colostogram to be the best study.This consists of the injection of hydrosoluble contrast material through the distal stoma. The study must be done under fluoroscopy, in the lateral position, using a Foley catheter with the balloon inflated in the distal stoma.
Read an in-depth description of distal colostogram
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