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Comparison Between the Pouch‐Perineum Distance in Neonates With a Low‐Type Anorectal Malformation With and Without an Opened Fistula: Pitfall of Measuring the Pouch‐Perineum Distance on Sonography
Author(s) -
Hosokawa Takahiro,
Takahashi Hiroaki,
Tanami Yutaka,
Sato Yumiko,
Tanaka Yujiro,
Kawashima Hiroshi,
Hosokawa Mayumi,
Oguma Eiji,
Yamada Yoshitake
Publication year - 2018
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14636
Subject(s) - perineum , pouch , medicine , fistula , surgery
Objective An anorectal malformation (ARM) in neonates requires urgent surgery, with the type of surgery being dependent on the type of malformation (low, intermediate, or high). Distal rectal pouch and perineum (pouch‐perineum) distance is reported to be useful for differentiating the type of ARM; however, the impact of an opened fistula on pouch‐perineum distance is not well known. The purpose of this study was to evaluate the difference in pouch‐perineum distance between neonates with a low‐type ARM with and without an opened fistula. Methods We included 24 neonates with low‐type ARM who underwent sonography before surgery. Eight neonates already had an opened fistula before sonography, and 16 did not. The pouch‐perineum distance was measured using the perineal approach. Mann‐Whitney U and Spearman's correlation coefficient tests were used for statistical analysis. Results The mean pouch‐perineum distance in all neonates with a low‐type ARM was 8.3 ± 2.9 mm. The pouch‐perineum distance was substantially longer for an ARM with than without an opened fistula (10.6 ± 3.4 mm vs. 7.1 ± 1.7 mm; P = .02). No appreciable correlation was identified between the pouch‐perineum distance and the postnatal day of examination (ρ = −.23, P = .26) or birth weight (ρ = .15, P = .47). Conclusion The pouch‐perineum distance is substantially longer in neonates with an ARM with an opened fistula than in those without an opened fistula. Caution should be exercised by the sonographic examiner in evaluating pouch‐perineum distance in neonates with an opened fistula to prevent an incorrect surgical procedure based on misdiagnosis of the type of ARM.