Anorectal malformations - their impact on early phases in life

Detta är en avhandling från Paediatrics, Faculty of Medicine, Lund University

Sammanfattning: Abstract:

Background : Anorecta l malformation s (ARM) occur in 4: 10000 newborn children with the gender distribut ion 1:1.5 females:males. The reconstruction of ARM, posterior sagiccal anorectal plasty (PSARP), was implemenred worldwide in the late 1980s and therefore the follow-ups are limited.

Aims: To assess bowel symptoms in children and adolescents with ARM, operated on with PSARP, and to evaluate the qualicy oflife (QoL) and sexual health among the same adolescents. To evaluate the outcome of appendicostomy in preschool children with ARM. To study the anatomical status of the pelvic floor, and its possible correlation with bowel symptoms, among females with ARM.

Results: Fecal incontinence was reported by 45% of the 121 children, and by 75% of the 24 adolescents. Constipation was reported by 50% children and 83% adolescents. Symptoms were more frequenr among females than males with the same subcype of ARM. Physically related QoL was lowered for females with ARM , while the mental domains in QoL were higher for the males with ARM compared with healthy conrrols. Jnrimate situations were influen ced by gas and fecal incontinence for both genders. Appendico stomy in 17 preschool children with ARM improved the fecal continence significand y, but 43% had minor complications. All 17 females with ARM examined with perineal ultrasonograph y had multiple defects on the anal sphincter, withour correlation with the degree of bowel symptom s.

Conclusion: Bowcl symptoms in chi ldren and adolcscenrs with ARM arc considerable and gender differen ces arc present. "fhe QoL and sexual health are i nAuenced both by gas and feca l incontin ence, and by self-efficacy, so directed psychological support could be valuable. Appendicostomy in preschool children is successful and wi ll be continued. Al l pregnant females with ARM should preferab ly be recommended to deliver by cesarian section.