Year 2024 Vol. 32 No 1

SCIENTIFIC PUBLICATIONS

M.D. LEVIN

CONGENITAL ANAL STENOSIS (ETIOLOGY, PATHOGENESIS, DIAGNOSIS AND TREATMENT)

Department of Pediatric Radiology of the 1st State Hospital, Minsk,
Republic of Belarus
Dorot Medical Center for Rehabilitation and Geriatrics Netanya, Israel

Objective. Congenital anal stenosis (CAS) is a rare form (2%) of anorectal malformations (ARM). All authors acknowledge the presence of the anal canal, but there are different ideas about the pathological anatomy and physiology of the CAS. Some believe that stenosis occupies a short distance between the wall of the anal canal and the anus. Others claim a long taper up to the dentate line. The volume of the operation depends on this. In the first case, the stenosis is dissected, and in the second, a pull-through operation is performed that destroys the anal canal.
Methods. To detail the anatomy of the CAS, we analyzed X-ray studies of the CAS from our own experience and from literature sources to determine the length and location of the narrowed segment, as well as the width of the rectum, using our radiometric method.
Results. A total of 7 X-ray studies of patients with CAS were analyzed, as well as 82 X-ray studies of different types of ARM. It has been shown that all forms of ARM, except for the true cloaca, develop in the embryological period in the same way with the formation of the anal canal because of the advancement of the internal anal sphincter (IAS) in the craniocaudal direction. The absence of the anus indicates that the exogenous rudiment of the anal canal does not move upward to meet the endogenous one. Therefore, penetration of the IAS beyond the anal canal leads to the formation of a narrow, rigid ring. If IAS penetrates through the subcutaneous tissue and skin, then CAS is formed. In other cases, the anus moves forward and upward, emerging outward or into any cavity, forming an ectopic anus onto the perineum, vestibule, urethra, or into the vagina.
Conclusion. Congenital anal stenosis is one of the forms of ARM, characterized by the presence of a normal anal canal, where the stenosis of the normally located anus has a length of 2 to 5 mm. X-ray examination provides an accurate anatomical and physiological characteristic of the defect. Treatment should be carried out as early as possible to prevent the development of megacolons. Dissection of the rigid ring and insertion of a tube into the anal canal can lead to complete recovery. A hypothesis of the embryological development of ARA is described.

Keywords: Anorectal malformations; congenital anal stenosis; embryology of anorectal malformations; X-ray examination; surgery
p. 52-60 of the original issue
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Address for correspondence:
4220200, Dorot
Medical Center for Rehabilitation and Geriatrics
Netanya. Israel
Tel: 972 53 8281393
e-mail: nivel70@hotmail.com
Levin Michael D.
Information about the authors:
Levin Michael D., MD, PhD, DSc, Radiologist, Department of Pediatric Radiology of the 1st State Hospital, Minsk, Republic of Belarus, Dorot. Medical Center for rehabilitation and geriatrics, Netanya, Israel.
https://orcid.org/0000-0001-7830-1944
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