Mehmet Hanifi OKUR, Murat Kemal ÇİĞDEM, ABDURRAHMAN ÖNEN, Selçuk OTÇU

Anorektal malformasyonlu olgularda klinik deneyimimiz: 115 olgunun analizi

Amaç: Bu çalışmada, anorektal malformasyonlu (ARM) hastalar ile ilgili deneyimlerimizi ve bunlarla beraber görü- len anomalileri sunmayı amaçladık. Yöntemler: 2000-2006 tarihleri arasında kliniğimizde ARM nedeniyle takip ve tedavi edilen 115 olgu geriye dö- nük olarak değerlendirildi. Olgularda genel sistem muayenesi, perineal muayene, laboratuar, direk grafi, ultrasonografi, ekokardiyografi ve gereğinde işeme sistoüretrografisi yapılarak ARM tipi ve ek anomaliler araştırıldı. Olgular ARM çeşidi ve sistem patolojisine göre sınıflandırıldı. Bulgular: Olguların %40,8i yüksek tip, %31,3ü alçak tip, %17,3ü intermedier tip, %9,5i anteriyor yerleşimli ektopik anüs ve %0,86sı kloakal malformasyon idi. Tüm olguların %48,6sında ek anomaliye rastlandı. Ek anomali en sık yüksek tipte (%59,5) görüldü. Kolostomi yapılan 80 olgunun, 56sına (%70) sağ transvers loop kolostomi, kalan 24 (%30) olguya ise yüksek sigmoid kolostomi yapıldı. Sağ transvers loop kolostomi yapılan olguların %17,8sinde kolostomi prolapsusu saptandı. Sonuçlar: ARMli hastaların ilk başvuru ve sonraki takibinde perine muayenesinin dikkatli yapılması ve ek anomali açısından detaylı tetkik edilmesi faydalıdır. Bu olgularda ekokardiyografi, ultrasonografi, distal kolostogram, tüm vücut grafisi ve bazı olgularda işeme sistoüretrografisi faydalıdır. Anorektal malformasyonlu tek seans planlanmayan hastalara yüksek ayrık sigmoid kolostomi uygulaması komplikasyonları azaltabilir.

Our clinical experience on anorectal malformations: Analysis of 115 cases

Objective: In this study, we aimed to evaluate our results on children with anorectal malformations (ARM) and associated anomalies. Methods: A total of 115 children who treated and followed in our clinic between 2000 and 2006 were retrospectively evaluated. Physical examination including perineal region, laboratory exams, abdominal X-ray, ultrasonography, echocardiography, and voiding cystourethrography when necessary were done to determine the type of ARM and associated anomalies. The patients were classified according to type of ARM and other pathologies. Results: Of the patients, 40.8% had high type ARM, 31.3% had low type, 17.3% had intermediate type, 9.5% had ectopic anterior located anus, and 0.86% had cloacal malformation. Associated anomalies were seen in 48.6% of patients. Associated anomalies were most commonly seen in high type of ARM patients (59.5%). Colostomy was performed in 80 patients; right transverse loop colostomy was performed in 56 (70%) cases, while high sigmoid colostomy was performed in 24 remaining cases. Stoma prolapse was developed in 17.8% of patients who underwent right transverse loop colostomy. Conclusion: It is crucial to examine perineal area carefully during the first admission and follow-up to determine the type of ARM and associated anomalies. It is beneficial to perform ultrasonography, echocardiography, distal colostogram, X-ray, and voiding cystourethrography when necessary. High divergent sigmoid colostomy may decrease complication rate in ARM patients.

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