29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Background/ Purpose:ten to twenty percent of cases of imperforate anus are questionable with no clinical evidences support the diagnosis of the level of the anomaly. The diagnostic tests used to determine the level of defect are not accurate enough and the surgeon may subject the patient to an unneeded colostomy while the level of the anomaly was low. The aim of this study is test the feasibility of using antegrade endoscopic transillumination to give precise knowledge about the level of the anomaly in these questionable cases and thus help in the proper management.

Materials & Methods: This is a prospective study comprising ten newborns boys with questionable level of imperforate anus admitted through the emergency unit of surgery department from May 2007 to April 2009. All Patients had sigmoidostomy 24-72 hours after having failed to pass the meconium.  A pediatric size flexible sigmoidoscope was introduced through the distal pouch of the sigmoid and the distal termination of the rectum was clearly identified. Bright transperineal transilluminationof the endoscopic light indicated a low malformation amenable to transanal anoplasty with closure of the sigmoidostomy. Poor or no transilluminationindicated a higher defect that needed staged posterior sagittal anorectoplasty.

Results:Ten boys were admitted, Six of them had low anomaly and showed bright transperineal transilluminationand were managed by endoscopic-assisted anoplasty. Four patients had high anomaly with no transperineal transilluminationand their operations were converted to staged posterior sagittal anorectoplasty. There were no operative complications. All patients with low anomaly (6 patients) were followed regularly in the outpatient clinic; the median follow up period was 6 months. All had a good anal size; four of them had mild to moderate constipation and respond well to medical treatment.

Conclusion: the use of antegrade endoscopic transilluminationin questionable cases of imperforate anus helps in reaching the proper diagnosis, safe identification and reconstruction of the new anus and avoidance of unneeded colostomy in cases with low anomaly.

Index Word:endoscopic transillumination, imperforate anus.

Background/ Purpose:ten to twenty percent of cases of imperforate anus are questionable with no clinical evidences support the diagnosis of the level of the anomaly. The diagnostic tests used to determine the level of defect are not accurate enough and the surgeon may subject the patient to an unneeded colostomy while the level of the anomaly was low. The aim of this study is test the feasibility of using antegrade endoscopic transillumination to give precise knowledge about the level of the anomaly in these questionable cases and thus help in the proper management.

Materials & Methods: This is a prospective study comprising ten newborns boys with questionable level of imperforate anus admitted through the emergency unit of surgery department from May 2007 to April 2009. All Patients had sigmoidostomy 24-72 hours after having failed to pass the meconium.  A pediatric size flexible sigmoidoscope was introduced through the distal pouch of the sigmoid and the distal termination of the rectum was clearly identified. Bright transperineal transilluminationof the endoscopic light indicated a low malformation amenable to transanal anoplasty with closure of the sigmoidostomy. Poor or no transilluminationindicated a higher defect that needed staged posterior sagittal anorectoplasty.

Results:Ten boys were admitted, Six of them had low anomaly and showed bright transperineal transilluminationand were managed by endoscopic-assisted anoplasty. Four patients had high anomaly with no transperineal transilluminationand their operations were converted to staged posterior sagittal anorectoplasty. There were no operative complications. All patients with low anomaly (6 patients) were followed regularly in the outpatient clinic; the median follow up period was 6 months. All had a good anal size; four of them had mild to moderate constipation and respond well to medical treatment.

Conclusion: the use of antegrade endoscopic transilluminationin questionable cases of imperforate anus helps in reaching the proper diagnosis, safe identification and reconstruction of the new anus and avoidance of unneeded colostomy in cases with low anomaly.

Index Word:endoscopic transillumination, imperforate anus.