ARM

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ARM

  1. 1. ANORECTAL MALFORMATION Approach Of A Pediatrician To A Case Of Newborn With ANORECTAL MALFORMATION Speakers -Dr.Sushmita Ghosh Moderator-Dr.M.K.Mohanty(Paed.Surgeon)Jawaharlal Nehru Hospital & Research Centre Bhilai Steel Plant Hospital dnbpaediatrics.blogspot.in
  2. 2. INTRODUCTION Anorectal malformation- Complex disorder ranging from cloaca (most severe) to perineal fistula. Invertogram- in 1930 Upto 1948 Surgical correction-Rhodes Since 1982- PSARP by Alberto Pena dnbpaediatrics.blogspot.in
  3. 3. ROLE OF PEDIATRICIAN Intramural Extramural(delivery-own hosp.)*diagnosis (outside delivery)*initial stabilization *diagnosed outside*referral to paed.surgeon *stabilization *treatment of sepsis,if any dnbpaediatrics.blogspot.in
  4. 4. BABY DELIVEREDTHOROUGH CLINICAL EXAMINATIONANORECTAL MALFORMATION(ARM) MALE FEMALE dnbpaediatrics.blogspot.in
  5. 5. NEWBORN WITH ARM (MALE) PERINEAL INSPECTION AND URINALYSISCLINICAL EVIDENCE(80-90%) QUESTIONABLE( 10-20%)PERINEAL FISTULA “FLAT BOTTOM” INVERTOGRAM“BUCKET HANDLE” MECONURIAMIDLINE RAPHE FISTULA AIR IN BLADDERANAL STENOSIS (XRay Finding)ANAL MEMBRANE >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DISTANCE dnbpaediatrics.blogspot.in
  6. 6. BUCKET HANDLE VARIETYdnbpaediatrics.blogspot.in
  7. 7. MIDLINE RAPHE FISTULAdnbpaediatrics.blogspot.in
  8. 8. NEWBORN WITH ARM (FEMALE) PERINEAL INSPECTION FISTULA(APPROX.90%) NO FISTULA(APPROX.10%)SINGLE OPENING TWO OPENINGs THREE OPENINGsCLOACA VAGINAL CUTANEOUS OR (PERINEAL) INVERTOGRAM VESTIBULAR >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DIST. dnbpaediatrics.blogspot.in
  9. 9. CLOACAdnbpaediatrics.blogspot.in
  10. 10. VAGINAL FISTULAdnbpaediatrics.blogspot.in
  11. 11. VESTIBULAR FISTULA WITH IMPERFORATE HYMEN dnbpaediatrics.blogspot.in
  12. 12. VESTIBULAR FISTULA dnbpaediatrics.blogspot.in
  13. 13. VAGINAL FISTULAdnbpaediatrics.blogspot.in
  14. 14. INCIDENCE WORLDWIDE 1:5,000 LIVE BIRTHS GENETIC PREDISPOSITION IN CERTAIN FAMILIES ASSOCIATION WITH CERTAIN SYNDROMES- VACTERL,VATER,DOWN’S SYNDROME SLIGHT MALE PREPONDERANCE IN FEMALES-RECTOVESTIBULAR FISTULA MOST COMMON IN MALES -RECTOURETHRAL FISTULA MOST COMMON dnbpaediatrics.blogspot.in
  15. 15. INITIAL MANAGEMENT RED RUBBER CATHETER INSERTION NBM & INTRAVENOUS FLUIDS FIRST LINE ANTIBIOTICS- CLOXACILLIN & AMIKACIN INJECTION VITAMIN K NASOGASTRIC DECOMPRESSION after 24 hrs dnbpaediatrics.blogspot.in
  16. 16. ASSOCIATED MALFORMATIONS (50-60%) UROGENITAL- URINARY-UNILATERAL AGENESIS OF KIDNEY -PUJ OBSTRUCTION -HYPOSPADIAS -VUR GENITAL- BICORNUATE UTERUS -UTERUS DIDELPHYS -VAGINAL SEPTUM -BLIND HEMIVAGINA -ATRESIA OF CERVIX -HYDROCOLPOS CARDIOVASCULAR- 1/3RD Pts -ASD,PDA most common -VSD,TOF dnbpaediatrics.blogspot.in
  17. 17. GASTROINTESTINAL-TRACHEOESOPHAGEAL ANOMALIES -DUODENAL OBSTRUCTION (ATRESIA/MALROTATION)SPINOVERTEBRA L -HEMIVERTEBRAE -SCOLIOSIS -HEMISACRUM -ABSENT SACRUM -BUTTERFLY VERTEBRAE - TETHERED CORD -SPINAL LIPOMAS -SYRINGOMYELIA -MYELOMENINGOCELE dnbpaediatrics.blogspot.in
  18. 18. INVESTIGATIONS INVERTOGRAM(10-20% CASES) -by Wangensteen and Rice(1930) PRONE CROSS TABLE LATERAL XRAY -by K.L.N Rao et al(1991) BABYGRAM ULTRASOUND ABDOMEN ECHOCARDIOGRAPHY dnbpaediatrics.blogspot.in
  19. 19. INVERTOGRAMDONE AFTER 16-18 HRS dnbpaediatrics.blogspot.in
  20. 20. WHY?dnbpaediatrics.blogspot.in
  21. 21.  AT BIRTH - GAS IN STOMACH 6-8 HRS - GAS REACHES ILEOCAECAL JUNCTION 12-18 HRS - GAS REACHES RECTUM dnbpaediatrics.blogspot.in
  22. 22. INVERTOGRAM -position dnbpaediatrics.blogspot.in
  23. 23. dnbpaediatrics.blogspot.in
  24. 24. dnbpaediatrics.blogspot.in
  25. 25. dnbpaediatrics.blogspot.in
  26. 26. dnbpaediatrics.blogspot.in
  27. 27. dnbpaediatrics.blogspot.in
  28. 28. PRONE CROSS TABLE LATERAL XRAY-position dnbpaediatrics.blogspot.in
  29. 29. PRONE CROSS TABLE LATERAL XRAY dnbpaediatrics.blogspot.in
  30. 30. Visit and join dnbpaediatrics.blogspot.inFree blog for postgraduates in pediatrics

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