Preoperative fistula diagnostics in male anorectal malformations after colostomy: a single-center experience.
Anorectal malformations
Colostogram
Fistula
MRI
VCUG
Journal
BMC medical imaging
ISSN: 1471-2342
Titre abrégé: BMC Med Imaging
Pays: England
ID NLM: 100968553
Informations de publication
Date de publication:
25 09 2023
25 09 2023
Historique:
received:
17
04
2023
accepted:
20
09
2023
medline:
4
10
2023
pubmed:
26
9
2023
entrez:
25
9
2023
Statut:
epublish
Résumé
Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy. A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded. Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed. High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
Sections du résumé
BACKGROUND
Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy.
METHODS
A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded.
RESULTS
Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed.
CONCLUSION
High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
Identifiants
pubmed: 37749545
doi: 10.1186/s12880-023-01105-3
pii: 10.1186/s12880-023-01105-3
pmc: PMC10521448
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
139Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Eur J Pediatr Surg. 2016 Dec;26(6):494-499
pubmed: 26752614
Pediatr Radiol. 2013 Aug;43(8):958-63
pubmed: 23460374
Pediatr Radiol. 2018 Feb;48(2):258-269
pubmed: 28840291
J Pediatr Surg. 2019 Dec;54(12):2550-2553
pubmed: 31495505
Semin Pediatr Surg. 2019 Jun;28(3):131-134
pubmed: 31171146
Semin Pediatr Surg. 2020 Dec;29(6):150986
pubmed: 33288132
Eur Radiol. 2015 Dec;25(12):3472-9
pubmed: 26002129
Indian J Radiol Imaging. 2010 May;20(2):122-5
pubmed: 20607024
Orphanet J Rare Dis. 2007 Jul 26;2:33
pubmed: 17651510
J Pediatr Surg. 2013 Aug;48(8):1806-9
pubmed: 23932626
Indian J Radiol Imaging. 2018 Apr-Jun;28(2):187-194
pubmed: 30050242
J Pediatr Surg. 2020 Feb;55(2):354
pubmed: 31718867
Pediatr Radiol. 2017 Sep;47(10):1369-1380
pubmed: 28852767
Semin Pediatr Surg. 2020 Dec;29(6):150997
pubmed: 33288131
Lancet Child Adolesc Health. 2017 Dec;1(4):323-330
pubmed: 30169187
Clin Colon Rectal Surg. 2018 Mar;31(2):61-70
pubmed: 29487488
J Pediatr Surg. 2017 Jul;52(7):1207-1209
pubmed: 28381335
BMC Pediatr. 2021 Jun 16;21(1):283
pubmed: 34134660
European J Pediatr Surg Rep. 2020 Jan;8(1):e39-e44
pubmed: 32550125
Pediatr Radiol. 2022 Aug;52(9):1802-1809
pubmed: 35648164
Pediatr Surg Int. 1997 Jul;12(5-6):383-5
pubmed: 9244105
Birth Defects Orig Artic Ser. 1988;24(4):231-46
pubmed: 3067766
J Pediatr Surg. 2019 Aug;54(8):1708-1710
pubmed: 31076157