8/14/2019 Perineal Canal PSI 1997 1

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Pediatr Surg Int (1997) 12 :28 3-2 85 Springer-Verlag 1997

A . Wa k h l u A . P a n d e y A . P r a s a d S . N . K u r e e lR . K . T a n d o n A . K . Wa k h l u

Per inea l canal

Accepted: 9 May 1996

A b s t r a c t P e r i n e a l c a n a l ( P C ) i s a r a r e a n o m a l y c o n s t i t u t -i n g 4 % o f a ll a n o r e c t a l m a l f o r m a t i o n s . S i x t y p a t i e n ts ( 5 6

f e m a l e s a n d 4 m a l e s ) w i t h P C m a n a g e d o v e r t h e p a s t2 7 y e a r s a r e r e p o r t e d . T h e a g e s r a n g e d f r o m 2 d a y s t o1 3 y e a r s . T h e c h i e f s y m p t o m w a s p a s s a g e o f f e c a l m a t te rt h r o u g h b o t h t h e a n u s a n d t h e f i s t u l a . O n e g i r l h a d u n d e r -g o n e p r e v i o u s , u n s u c c e s s f u l s u r ge r y. A l l o u r pa t i e nt s w e r et r e a t e d b y a n t e r i o r s a g i t t a l a n o r e c t o p l a s t y ( A S A R P ) , w h i c ha l l o w e d a n a t o m i c e x p o s u r e a n d a c c u r a t e r e p a ir o f th ea n o m a l y. I n 4 9 p a t ie n t s w i t h o u t a n y p e r i n e a l i n f l a m m a t i o np r i m a r y A S A R P w a s u n d er t ak e n . S u r g e r y w a s d e l a y e d i n11 p a t i e n t s w i t h p e r i n e a l e x c o r i a t i o n s a n d / o r a c t i v e i n f l a m -m a t i o n . O n e p a t i e n t d i e d p o s t - o p e r a t i v e l y d u e t o u n r e la t e dc a u s e s a n d 1 d e v e l o p e d a r e c u r re n c e . A n a l d i l a ti o n w a sr e q u i r e d i n 7 c a s e s . F i f t y p a t i e n t s w e r e s e e n a t f i r s t f o l l o w -

u p 1 2 w e e k s a f te r s u r g er y. A l l w e r e c o n t i n e n t a n d h a dn o r m a l d e f e c a t i o n w i t h o u t t h e u s e o f l a x a ti v e s . T h i r t y - f o u rc o u l d b e f o l l o w e d u p t o t h e a g e o f 3 y e a rs ; t h e y w e r ec o n t i n e n t w i t h n o r m a l b o w e l h a b i t s . T h e r e w a s n o s h i f t i nt h e p o s i t i o n o f t h e a n u s a n d n o i n s t a n c e o f r e c t a l d i la t i o n .I n d i v i d u a l i z a t io n o f t h e m a n a g e m e n t a n d o p e r a t i o n b y t h ea n t e r i o r s a g i t t a l a p p r o a c h t h u s o f f e r s g o o d r e s u l t s i n t h isu n c o m m o n a n o r e c t a l a n o m a l y.

K e y w o r d s A n o r e c t a l m a l f o r m a t i o n s P e r i n e a l c a n a l A n t e r i o r s a g i t t a l a n o r e c t o p l a s t y

introduction

T h e t e r m " p e r i n e a l c a n a l " ( P C ) w a s c o i n e d b y S t e p h e n s a n dS m i t h [ 1 0 ] in 1 9 7 1 f o r an a n o r e c t a l m a l f o r m a t i o n ( A R M ) i n

A. Wakhlu A. Pandey A. Prasad S. N. K ureel R. K. Tandon A. K. WakhluDivision of Pediatric Surgery, Department of Surgery, King G eorge'sMedical College, Lucknow, Uttar Pradesh, India

A. K. Wakhlu (~ )B 1 -99 Sector 'G ', Aliganj, Lucknow 226020, UR India

w h i c h t h e r e i s a f i s t u l a b e t w e e n t h e a n t e r i o r w a l l o f an o r m a l l y - f o r m e d a n u s / r e c t u m a n d t h e v e s t i b u l e / p e r i n e u m

i n fe m a l e s o r t h e p e r i n e u m / a n t e r i o r u r e t h r a i n m a l e s . S i n c et h e in i ti a l re p o r t s b y B r y n d o r f a n d M a d s e n [ 1] a n d P e g u me t a l . [ 7 ] , p a t i e n t s w i t h P C h a v e b e e n r e p o r t e d m o s t l y f r o mA s i a n c o u n t r i e s [ 3 ] . A l t h o u g h t h e d i a g n o s i s i s s t r a i g h t f o r -w a r d , t h e c o n v e n t i o n a l t r e a t m e n t o f th i s a n o m a l y l e a v e sm u c h t o b e d e s i r e d . T h e p r e s e n t p a p e r d e t a i l s o u r e x p e r i -e n c e w i t h t h e m a n a g e m e n t o f P C o v e r t he p a s t 2 5 y e ar s . Wea l s o d e s c r i b e a s u rg i c a l t e c h n i q u e t h a t h a s g i v e n c o n s i s -t e n t l y g o o d r e s u l t s .

Mater ia ls and methods

Of 1600 patients with ARM treated at our hospital between 1969 an1995, there were 60 with PC (3.8%), who constituted 7.3% (56/776) ofemales with ARM (Table 1).

In female patients the chief symptom was defecation through boththe anus and the fistula (Table 2). The parents of one 6-year-old girattributed the malformation to a s exu al assault. In another girl wit

Table 1 Ag e and sex distribution of the patients

Ag e Males Females

Neonate 2 4Infant 1 37Child 1 15

Total 4 56

Table 2 Presenting features

Symptoms No. of patients

Passage of feces through both anus and fistula 48

Passage of feces through fistula only due to 12severe anal spasm

Perineal excoriation 7

Perineal abscesses 4

Persistent vaginal discharge 1