Journal of pediatric surgery · 2025
Versatility of contrast enhanced colosonography for pre-operative evaluation of anorectal malformation with fistula.
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Etskovitz Haley, Rincon-Cruz Lorena, Kim Rosa S, Chow Jeanne, Nandivada Prathima, Dickie Belinda Hsi
Аннотация
INTRODUCTION: Anorectal malformations (ARM) with fistulae require anatomic definition of the fistula and distal extent of the rectum relative to the coccyx prior to posterior sagittal anorectoplasty (PSARP). We previously validated contrast enhanced colosonography (CECS) as a safe and accurate modality to characterize ARM. The purpose of this study is to evaluate the application of CECS in various clinical settings and its reliability in the newborn population.
METHODS: We performed a single-center retrospective case series of 50 patients with ARM who underwent evaluation with CECS from 2016-2024. All patients underwent staged reconstruction with an ostomy. CECS findings were compared to intra-operative findings to evaluate accuracy.
RESULTS: CECS accurately identified the presence and level of fistula, and position of the distal colon relative to the coccyx in 100% of patients: no fistula (n=8), bulbar rectourethral fistula (n=16), prostatic rectourethral fistula (n=22), bladder neck fistula (n=2), rectovestibular fistula with vaginal atresia (n=1), complex rectourethral fistula (n=1). CECS was performed on inpatient newborns (< 31d) (n=7), inpatient infants (n=11), outpatient infants (n=26), and infants in the operating room (n=6). No newborns developed surgical site infections or mucous fistula stricture from early manipulation. CECS allowed for concurrent spinal (n=10) and renal (n=15) ultrasounds, and contrastenhanced voiding urosonography (n=11).
CONCLUSION: CECS is safe and reliable for pre-operative characterization of ARM with fistula. It can be performed in various clinical settings on newborns and infants, allowing for early prognostication, operative planning, and comprehensive counseling. CECS offers an advantage in its ability to perform concurrent VACTERL screening.
METHODS: We performed a single-center retrospective case series of 50 patients with ARM who underwent evaluation with CECS from 2016-2024. All patients underwent staged reconstruction with an ostomy. CECS findings were compared to intra-operative findings to evaluate accuracy.
RESULTS: CECS accurately identified the presence and level of fistula, and position of the distal colon relative to the coccyx in 100% of patients: no fistula (n=8), bulbar rectourethral fistula (n=16), prostatic rectourethral fistula (n=22), bladder neck fistula (n=2), rectovestibular fistula with vaginal atresia (n=1), complex rectourethral fistula (n=1). CECS was performed on inpatient newborns (< 31d) (n=7), inpatient infants (n=11), outpatient infants (n=26), and infants in the operating room (n=6). No newborns developed surgical site infections or mucous fistula stricture from early manipulation. CECS allowed for concurrent spinal (n=10) and renal (n=15) ultrasounds, and contrastenhanced voiding urosonography (n=11).
CONCLUSION: CECS is safe and reliable for pre-operative characterization of ARM with fistula. It can be performed in various clinical settings on newborns and infants, allowing for early prognostication, operative planning, and comprehensive counseling. CECS offers an advantage in its ability to perform concurrent VACTERL screening.