Carlos A.Reck-Burneo MD FAAP, Wilfried Krois MD


Introduction

Anorectal Malformations affect 1 in 5000 newborn children worldwide. In most cases, a colostomy is performed. An interval contrast enema of the distal colostomy is performed to define the abnormality and the opening of the rectum. The rectum ends in most cases somewhere into the urinary tract.
This procedure can be done after the stoma has healed and implies exposing the child to radiation and the discomfort of injecting high-pressure contrast into the distal end, causing significant discomfort. This often delays the diagnosis, so we explored a bedside option for diagnosing, classifying, and planning the surgery without trauma, pain, or radiation exposure by doing a pelvic ultrasound and a 3d reconstruction with a PIUR tomographic ultrasound imaging system.


Case description

A newborn on gestational week 36 weeks, was born by normal delivery with 2600 g to a healthy mother. Prenatal diagnosis was standard except for stage 3 Hydronephrosis seen on prenatal MRI. On examination, no anal opening was recognized by the pediatrician, and the patient was referred to us for further management. We performed a descendostomy and proceeded a few days later with a high-pressure distal colostogram that established a recto-bulbar fistula diagnosis. At the same time, we performed a tomographic ultrasound with a PIUR tUS Infinity system. This confirmed 3D reconstruction of the diagnosis (figure below). The image acquisition was much faster than distal colostogram and without distress to the child.


Discussion

The correct diagnosis and classification of anorectal malformations in children require, in most cases, a complex set of imaging modalities, including a distal colostogram and a pelvic MRI. These imaging procedures can cause significant distress to the child. In the case of MRI, sedation and general anesthesia are often required. For the distal colostogram, radiation and distress to the child are deterring.
We propose a new diagnostic protocol with 3D tomographic ultrasound to replace the distal colostogram. In the future, its use can be expanded, and a bedside diagnosis can be offered with no distress and exposure to radiation.

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