WOFAPS 2025 8th World Congress of Pediatric Surgery

Judith Lindert, Daniel Erkel, Naemi Kurzweil, Edyta Schmidt, Stefanie Märzheuser

Department of Paediatric Surgery, University Rostock

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Purpose
Patients with anorectal malformations (ARM) require regular assessment of fecal load. Using X-rays for evaluation exposes children to repetitive ionizing radiation. This study addresses the following questions:

1. Is it feasible to conduct routine clinician ultrasound measurements during colorectal outpatient clinics?

2. Is the transrectal diameter suitable for visualizing the neorectum in children with anorectal malformations, and is there a correlation between fecal load and symptoms?

3. Is it possible to monitor bowel management using the transrectal diameter in children with anorectal malformations?

Methods
Children with anorectal malformations (ARM), functional constipation, and healthy controls who presented to our colorectal clinic between 04/2023 and 03/2024 were included and compared in this prospective proof-of-concept observational cohort study. Ultrasound scans were performed at each visit, and the maximal horizontal transrectal diameter, including the rectal wall, was measured. We included 185 children with anorectal malformations, functional constipation, and healthy controls.

Results
We included 57 children with anorectal malformations (27 females, 30 males), with 48 months (mean) following reconstruction. 76 control subjects (35 females, 41 males) and 76 children with functional constipation (35 females, 41 males) were included as well. All children underwent a sonographic assessment of the transrectal diameter (TRD).

In asymptomatic children with ARM, the mean TRD was 2.20 cm, similar to healthy controls. Using point-of-care ultrasound, we effectively monitored bowel management while avoiding radiation exposure. Furthermore, our findings confirm that this TRD cut-off reliably distinguishes children with ARM with and without symptoms(p < 0.0001).