Unexpectedly deformed anal sphincter in low-type anorectal malformation.
OBJECTIVE
The sphincter muscles in anorectal anomalies, which do not appear in the surgical field, cannot be described adequately. Details of the anal sphincter in low-type anorectal malformations were investigated using 3-dimensional (3D) image analysis.


METHODS
Thirty patients (10 males and 20 females) with low-type anorectal malformation were investigated with multidetector-row helical computed tomography. An image of the anorectal part was obtained with a slice thickness of 1 mm and a reconstruction pitch of 0.5 mm. A 3D reconstruction on a personal computer was made with a volume rendering method assisted by our own software (NewVES).


RESULTS
Very thin vertical fibers (VFs) were observed behind the fistula in almost half of the low-type cases. They did not wrap the distal end of the fistula. The 3D images of these sphincters were different in each case.


CONCLUSIONS
The fistula was dislocated forward from the deformed hypoplastic sphincter. We suggest that surgical mobilization of the anorectum into the center of the hypoplastic sphincter would be difficult using the cut back or Potts methods.


CONCLUSIONS
The choice of surgical method should take into consideration the displaced and deformed hypoplastic anal sphincter.
Watanabe
Yoshio
Y
Aichi Children's Health and Medical Center, Obu-city, Aichi 474-8710, Japan. yoshio_watanabe@mx.achmc.pref.aichi.jp
Takasu
Hidemi
H
Mori
Kensaku
K
D001003:Anal Canal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D012003:Rectal Fistula / Q000151:congenital* / Q000473:pathology / Q000601:surgery; D012007:Rectum / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D012984:Software; D036542:Tomography, Spiral Computed / Q000706:statistics & numerical data