Introduction: Anorectal malformation (ARM) is a wide spectrum of congenital malformations involving the distal rectum and anus as well as the urinary and/or gynaecological systems with an estimated incidence ranging between 1 in 2000 and 1 in 5000 live. Types of fistulas are essential to diagnose to decide the management and surgical repair. We review several fistula types of anorectal malformation based on distal loopography examination.
Case Presentation: Review of 5 patients with distal loopography in Sanglah Hospital was performed. All patients were neonate with absence of the anus without any clues of fistulas. Â Plain abdominal x-ray and knee-chest position showed distended loops of bowel and blind-ending of distal rectum with various distance from anal dimple. Two cases were confirmed as high type of ARM with recto-vesica fistula, where the contrast filled rectum and the bladder which decreased significantly after micturition. The two other cases were confirmed as high type ARM with recto-urethrae fistula, and the last one as low type of ARM with recto-perineal fistula. All patients undergoing surgical management for fistula repair and anorectal reconstruction.
Discussion: Anorectal malformation forms a heterogeneous group of anomalies, most cases showed imperforated anus and blind-ending of distal enteric component (atresia) with or without fistula. Our cases were diagnosed by plain x-ray and contrast study. High or low type was evaluated from the distance rectal pouch to anal dimple.Â Distal loopogram was showed low type of ARM with recto-perineal fistula and high type of ARM with fistula extended anteriorly as recto-vesica fistula and recto-urethrae fistula, as The Krickenbeck classifications.
Conclusion: Distal loopography is an important diagnostic investigation to delineate the altered anatomy of anorectal malformations, the location fistula and the spectrum of associated fistula between the blind rectum and the bladder, urethra, perineum, scrotal and vagina. Radiology interpretation is indeed important for clinician to establish patient management.