title: Comparison of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study and conventional contrast radiographic colostography in children with anorectal malformation.
abstract: BACKGROUND
  In children with high and intermediate anorectal malformation, distal colostography is an important investigation done to determine the relationship between the position of the rectal pouch and the probable site of the neo-anus as well as the presence or absence of a fistula. Conventionally, this is done using contrast with fluoroscopy or still X-ray imaging. This, however, has the challenges of irradiation, availability and affordability, especially in developing countries. This study compared the accuracy of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study (SCDS) with conventional contrast distal colostography (CCDC) in the determination of the precise location of the distal rectal pouch and in detecting the presence and site of fistulous communication between the rectum and the urogenital tract was studied.
  
  
  METHODS
  Trans-perineal ultrasound-guided pressure augmented SCDS, CCDC and intra-operative measurements were done sequentially for qualified infants with anorectal malformation and colostomy. Pouch skin distance and presence or absence of recto urinary or genital fistula was measured prospectively in each case. Statistical significance was inferred at P-value of <0.01.
  
  
  RESULTS
  There were thirteen infants, 9 males and 4 females. The age at onset of investigation ranged from 2 to 12 months with a median value of 9 months. Using paired t-test at a confidence interval of 95%, the P value when SCDS values are compared with CCDC is 0.19; and 0.06 when SCDS was compared with intra-operative measurements. Hence, there is no statistical difference as P > 0.01. On its ability to detect presence or absence of a fistula: SCDS had a sensitivity of 50.0%, specificity of 100.0%, accuracy of 69.2%, negative predictive value of fistulas of 55.6% and a positive predictive value of fistulas of 100.0%.
  
  
  CONCLUSIONS
  Ultrasound-guided pressure augmented SCDS can safely and reliably be used to assess the distal colonic anatomy and the presence of fistula in infants with Anorectal malformation who are on colostomy.
authors.affiliation: Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Okechukwu Hyginus
authors.initials: OH
authors.lastname: Ekwunife
authors.affiliation: Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Eric Okechukwu
authors.initials: EO
authors.lastname: Umeh
authors.affiliation: Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Jideofor Okechukwu
authors.initials: JO
authors.lastname: Ugwu
authors.affiliation: Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Uzoamaka Rufina
authors.initials: UR
authors.lastname: Ebubedike
authors.affiliation: Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Chinedu Christian
authors.initials: CC
authors.lastname: Okoli
authors.affiliation: Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Victor Ifeanyichukwu
authors.initials: VI
authors.lastname: Modekwe
authors.affiliation: Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Kelechi Collins
authors.initials: KC
authors.lastname: Elendu
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging*; D000071056:Anorectal Malformations / Q000000981:diagnostic imaging*; D003125:Colostomy; D003287:Contrast Media; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010502:Perineum / Q000000981:diagnostic imaging*; D012007:Rectum / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media