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Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations.
Authors:J K Niedzielski
Affiliation:Department of Pediatric Surgery and Oncology, Chidren's Hospital of Medical University in ?odz, ?odz, Poland. jniedzielski@surgery.pl
Abstract:
PURPOSE: To evaluate the usefulness, reliability and sensitivity of invertography, perineal ultrasonography (US) and augmented-pressure distal colostography (APDC) in the diagnostic assessment of children with anorectal malformations (ARM). MATERIAL AND METHODS: Author retrospectively analysed the results of bowel-skin distance measured by means of three different imaging techniques in 39 children with ARM. The obtained results were verified by intraoperative measurements. RESULTS: Sensitivity of invertography performed in 22 patients was 27 % with a mean error of measurement of 0.84 cm, and the difference between measurements and real distance was statistically significant. Sensitivity of perineal US (22 children) was 86 % (mean error 0.12 cm) and of APDC (26 patients) was 100 % (0.05 cm) with no significant difference between measurements and intraoperative findings (p > 0.001). CONCLUSIONS: The study revealed a limited usefulness of invertography in the diagnostic evaluation of ARM. Perineal US was extremely useful in the newborn period and provided reliable information on which to base a decision for either preliminary colostomy or definitive operation. With a colostomy in place APDC, the most sensitive of the three methods, allowed for later precise definition of the defect and visualization of fistulas between bowel and urogenital tract.
Keywords:
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