Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations.
OBJECTIVE
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).


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.
Niedzielski
J K
JK
Department of Pediatric Surgery and Oncology, Chidren's Hospital of Medical University in Łodz, Łodz, Poland. jniedzielski@surgery.pl
D001003:Anal Canal / Q000002:abnormalities / Q000000981:diagnostic imaging; D001006:Anus, Imperforate / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003106:Colon / Q000000981:diagnostic imaging*; D003125:Colostomy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010502:Perineum / Q000000981:diagnostic imaging*; D011859:Radiography; D012007:Rectum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography