Document Detail

An appraisal of invertograms and distal colostograms in the management of anorectal malformations.
MedLine Citation:
PMID:  15222518     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the accuracy of two main radiologic tools currently employed in the clinical management of anorectal malformations, the invertogram and the distal colostogram. The data will be useful as a basis for quality assurance as well as for future comparisons in case there are innovations to be considered. MATERIAL AND METHOD: Radiological materials and clinical records of infants with anorectal malformations operated on in Songklanagarind Hospital from 1995 to 2001 were retrieved. Each record was blindly reviewed by two radiologists and one pediatric surgeon. Using operative findings as the gold standard, the accuracy of an invertogram in diagnosing low anomalies and the accuracy of a distal colostogram in screening cases that needed a laparotomy and in detecting internal fistulas were determined. The quality of the films was also categorized and poor quality studies were excluded from the analysis. Cases of common cloaca were not included in the level reading analysis. RESULTS: Radiologic materials from 59 patients were examined, including 26 invertograms and 49 distal colostograms. Among 52 cases whose neonatal history could be traced, 29 (55.8%) cases exhibited clinical evidence of anomalies level. Two invertograms and 5 colostograms were graded as poor quality and excluded from the analysis. The overall sensitivity of invertograms in detecting low anomalies was 33.3%, whereas, specificity was 66.7%. Analyzing only infants with a blind rectal pouch, the sensitivity and specificity to detect low anomalies were 33.3% and 75.0%, respectively. The sensitivity of distal colostograms in detecting a fistula was 60.0% in males and 62.5% in females. Distal colostograms diagnosed 'high-type anomalies' in 7 cases and correctly detected 2 cases of vesical fistula which needed APSARP. No prostetic-urethral fistulas showed a radiological high level. CONCLUSION: The study found poor diagnostic sensitivity of invertograms in detecting low type anomalies which deserved primary anoplasty. However, the data support the role of a distal colostogram in diagnosing high anomalies, despite its low sensitivity in detecting urethral fistulas.
Suthas Horsirimanont; Surasak Sangkhathat; Panpen Utamakul; Jirawan Chetphaopan; Sakda Patrapinyokul
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the Medical Association of Thailand = Chotmaihet thangphaet     Volume:  87     ISSN:  0125-2208     ISO Abbreviation:  J Med Assoc Thai     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-06-29     Completed Date:  2004-08-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7507216     Medline TA:  J Med Assoc Thai     Country:  Thailand    
Other Details:
Languages:  eng     Pagination:  497-502     Citation Subset:  IM    
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkhla, Thailand.
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MeSH Terms
Colonic Pouches
Infant, Newborn
Predictive Value of Tests
Rectal Neoplasms / radiography*,  surgery
Rectum / radiography*
Reproducibility of Results
Retrospective Studies

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