Original article 178
Computed Tomography and Magnetic Resonance Tomography Findings in Children Operated for Anal Atresia E. Arnbjörnsson J, N. Malmgren 2,
Paediatric Surgery and the 2Department of Diagnostic Radiology, University of Lund, S·221 85 Lund, Sweden
Summary Computerised tomography and magnetic resonance tomography were performed in nine faecally incontinent patients more than eight years after rectoplasty for high imperforate anus. No statistically significant correlation was found between function, i. e. degree of faecal incontinence, and anatomical findings. Thus, in spite of a detailed demonstration of the post-operative anatomy, the information does not seem 10 be directly applicable in indicating a way to reoperate for faecal incontinence in this group of patients.
Key words Superior imperforate anus - Computed tomography (CT) - Magnetic resonance tomography (MR) Faecalincontinence
Computertomographie und Resonanztomographie zur postoperativen Beurteilung anorektaler Fehlbildungen Bei 9 stuhlinkontinenten Patienten wurde eine Computertomographie und eine Resonanztomographie mehr als 8 Jahre nach sakro-perinealem Durchzug durchgeführt. Wir fanden keinen Zusammenhang zwischen den Graden der Stuhlinkontinenz und der NMR-Anatomie. Trotz der sehr exakten Darstellung der Beckenboden-Ana1omie, konnte hieraus keine Indikation für eine Reoperation abgeleitet werden.
As we can now study our patients via computerised tomography (CT) and magnetic resonance tomography (MR), we are interested in finding out if there are any anatomical structures that are more important than others for the patients' faecal contro!. With this aim in mind we studied our incontinent patients operated on with rectoplasty for high anal atresia.
Material and methods The patient group consisted of nine incontinent children born with high anal atresia and operated on with rectoplasty during the first year of life. They were followed up more than eight years after the rectopIasty. Seven boys and two girls aged 9-15 years were included in the study. The CT equipment (Toshiba or Philips) delivered axial slices with a thickness of 5-6 mm. The magnet camera (Fonar) has a magnetic field strength of 0.3 T. We studied Tl-weighted axial, coronal and sagittal scans with a thickness of 7 mm. The anatomical structures studied with both CT and MR included the thickness of the lateral and posterior part of the levator muscle. We observed whether the rectum had been pulIed asymmetrically through this muscle at operation. We also studied whether the muscle was frayed and contained interposed fat planes. Finally we looked for a possible external sphincter. For definition of the patient group presented here, the results of an anorectal manometry study for each patient are shown in Table 1. The method of anorectal manometry used as weIl as the definitions used are published previously (1). The patients were ranked according to their faecal control. The anatomical findings measured in mrn were then ranked. A statistical analysis using Spearman's rank correlation test was used.
Schlüsselwörter Anorektale Fehlbildungen - Computertomographie - Magnetic-Resonanztomographie - Stuhlinkontinenz
Received January 15, 1989 Z Kinderchir 45 (1990) 178-181 © Hippokrates Verlag Stuttgart
Results A thin posterior part of the levator muscle (Fig. 1) was present in five cases, a thin lateral part in three patients. Four children had an asymmetrical position of the recturn (Fig. 2). Interposed fat planes with a frayed levator muscle (Fig. 3) could be seen in six patients, whereas a thin externat sphincter (Fig. 4) was present in two cases only. There was no statistical correlation between CT, MR, anorectal manometry findings and the degree of faecal control in this group of incontinent children (Tab. 1).
Downloaded by: University of Pennsylvania Libraries. Copyrighted material.
1Department of
c. Mikaelsson J, s. Laurin2, L. Okmian J
Figla
Fig.2a
Fig.lb
Fig.2b Fig. 2 a and b A nme year·old boy, Ineonllnen elgh ears a' e' reclo· pla5ty a) CT shows a marked asymmetry 0 he ree um 1'11 hrn he levator musel \'11 h a ry tlln lay r on Ih lef slde (arrow) b) The aXial R sean demons ra es h illre Indmg, al hough 1'11 h a lower resolution (arrows)
Discu'
Fig.le Fig. 1 a, band c A boy aged ears ilnd 1I1conl,nen nrne years after recloplasty a) The CT snows thaI here IS iI hln:a he e' 1!1 he ur...·h'a ilnd Cl rubber Faley ca heler In he r c um Th DOSI!!'Oor r'lon 0 ne e a or muscle (arrow) 15 hlOller han normal, whlcl 'las a COf'l010n tin Ing m hl~ pallen sroup operaled on or high anal a r sla b) An aXial MR slice d monstrates fhe sarr e ',1 olng (arrows) The sur roundlng fa y \I~ue \'llh high In enSI Signal provld,"s (Jod contras agaln5t he tower Signal rn ensl of museie tlsSU!! e) An example of normal CT ana omy 0 h lo\,/pr par of Ihe I .va or mus eie (arrow), wlth a weil deyeloped levil 01 51111&
iOD
The ab em:e of tOl'relal ion I 1\\ rn Ih .In·l m.\' a I' \' aJ d b} Tor .\IH, allel fundu)l1, m a.lIrrn a. rank cl paramel I' • i urpri 'ing, AJlhough on 1.\ nin pali nt lo k part in lhis slud.\'. thc I'e ults are lati ticall.\' ignificant L'nfortunateh', no cOIllinent paticn \\el'e in luded. ince for lhical raSOll il was iltlpo ibl to lurl) Ih
Computed Tomography and Magnetic Resonance Tomography Findings in Children Operated for Anal Atresia E. Arnbjörnsson J, N. Malmgren 2,
Paediatric Surgery and the 2Department of Diagnostic Radiology, University of Lund, S·221 85 Lund, Sweden
Summary Computerised tomography and magnetic resonance tomography were performed in nine faecally incontinent patients more than eight years after rectoplasty for high imperforate anus. No statistically significant correlation was found between function, i. e. degree of faecal incontinence, and anatomical findings. Thus, in spite of a detailed demonstration of the post-operative anatomy, the information does not seem 10 be directly applicable in indicating a way to reoperate for faecal incontinence in this group of patients.
Key words Superior imperforate anus - Computed tomography (CT) - Magnetic resonance tomography (MR) Faecalincontinence
Computertomographie und Resonanztomographie zur postoperativen Beurteilung anorektaler Fehlbildungen Bei 9 stuhlinkontinenten Patienten wurde eine Computertomographie und eine Resonanztomographie mehr als 8 Jahre nach sakro-perinealem Durchzug durchgeführt. Wir fanden keinen Zusammenhang zwischen den Graden der Stuhlinkontinenz und der NMR-Anatomie. Trotz der sehr exakten Darstellung der Beckenboden-Ana1omie, konnte hieraus keine Indikation für eine Reoperation abgeleitet werden.
As we can now study our patients via computerised tomography (CT) and magnetic resonance tomography (MR), we are interested in finding out if there are any anatomical structures that are more important than others for the patients' faecal contro!. With this aim in mind we studied our incontinent patients operated on with rectoplasty for high anal atresia.
Material and methods The patient group consisted of nine incontinent children born with high anal atresia and operated on with rectoplasty during the first year of life. They were followed up more than eight years after the rectopIasty. Seven boys and two girls aged 9-15 years were included in the study. The CT equipment (Toshiba or Philips) delivered axial slices with a thickness of 5-6 mm. The magnet camera (Fonar) has a magnetic field strength of 0.3 T. We studied Tl-weighted axial, coronal and sagittal scans with a thickness of 7 mm. The anatomical structures studied with both CT and MR included the thickness of the lateral and posterior part of the levator muscle. We observed whether the rectum had been pulIed asymmetrically through this muscle at operation. We also studied whether the muscle was frayed and contained interposed fat planes. Finally we looked for a possible external sphincter. For definition of the patient group presented here, the results of an anorectal manometry study for each patient are shown in Table 1. The method of anorectal manometry used as weIl as the definitions used are published previously (1). The patients were ranked according to their faecal control. The anatomical findings measured in mrn were then ranked. A statistical analysis using Spearman's rank correlation test was used.
Schlüsselwörter Anorektale Fehlbildungen - Computertomographie - Magnetic-Resonanztomographie - Stuhlinkontinenz
Received January 15, 1989 Z Kinderchir 45 (1990) 178-181 © Hippokrates Verlag Stuttgart
Results A thin posterior part of the levator muscle (Fig. 1) was present in five cases, a thin lateral part in three patients. Four children had an asymmetrical position of the recturn (Fig. 2). Interposed fat planes with a frayed levator muscle (Fig. 3) could be seen in six patients, whereas a thin externat sphincter (Fig. 4) was present in two cases only. There was no statistical correlation between CT, MR, anorectal manometry findings and the degree of faecal control in this group of incontinent children (Tab. 1).
Downloaded by: University of Pennsylvania Libraries. Copyrighted material.
1Department of
c. Mikaelsson J, s. Laurin2, L. Okmian J
Figla
Fig.2a
Fig.lb
Fig.2b Fig. 2 a and b A nme year·old boy, Ineonllnen elgh ears a' e' reclo· pla5ty a) CT shows a marked asymmetry 0 he ree um 1'11 hrn he levator musel \'11 h a ry tlln lay r on Ih lef slde (arrow) b) The aXial R sean demons ra es h illre Indmg, al hough 1'11 h a lower resolution (arrows)
Discu'
Fig.le Fig. 1 a, band c A boy aged ears ilnd 1I1conl,nen nrne years after recloplasty a) The CT snows thaI here IS iI hln:a he e' 1!1 he ur...·h'a ilnd Cl rubber Faley ca heler In he r c um Th DOSI!!'Oor r'lon 0 ne e a or muscle (arrow) 15 hlOller han normal, whlcl 'las a COf'l010n tin Ing m hl~ pallen sroup operaled on or high anal a r sla b) An aXial MR slice d monstrates fhe sarr e ',1 olng (arrows) The sur roundlng fa y \I~ue \'llh high In enSI Signal provld,"s (Jod contras agaln5t he tower Signal rn ensl of museie tlsSU!! e) An example of normal CT ana omy 0 h lo\,/pr par of Ihe I .va or mus eie (arrow), wlth a weil deyeloped levil 01 51111&
iOD
The ab em:e of tOl'relal ion I 1\\ rn Ih .In·l m.\' a I' \' aJ d b} Tor .\IH, allel fundu)l1, m a.lIrrn a. rank cl paramel I' • i urpri 'ing, AJlhough on 1.\ nin pali nt lo k part in lhis slud.\'. thc I'e ults are lati ticall.\' ignificant L'nfortunateh', no cOIllinent paticn \\el'e in luded. ince for lhical raSOll il was iltlpo ibl to lurl) Ih
