Anorectal Junction Stenosis: Diagnosis and Management

Abstract

Purpose: The aim of this paper is to describe the management of 9 patients with anorectal junction stenosis and present the diagnostic features together with a simple single-stage surgical technique with reproducible results. Materials and Methods: Nine patients with anorectal junction stenosis were seen over a period of 12 years. The children (aged from 2 months to 15 years) presented with constipation. Anorectal junction stenosis was diagnosed by rectal examination during which the tip of a finger was unable to pass beyond the stenotic ring at the upper end of the anal canal. A dilator, however, readily passed through the stenosis in all cases. Contrast study showed the dilated rectosigmoid proximal to the stenosis. Results: Six patients (who did not have significant rectal dilatation) underwent single-stage surgery by posterior Y‐V plasty which was curative. Two patients were operated through the posterior sagittal route with a covering colostomy done during the same session; the oldest child required resection of the megasigmoid with abdominoperineal pull-through. None of the six patients operated with Y‐V plasty experienced any complications. One of the patients operated via the posterior sagittal route had a leak from the anorectal anastomosis requiring revision. The follow-up ranged from 6 months to 12 years. All patients are alive and well and there was no recurrence of stenosis in any case. Conclusion: Anorectal junction stenosis is a rare anorectal anomaly easily diagnosed by digital rectal examination. Single-stage surgery by posterior Y‐V plasty is effective in curing the majority of these patients if significant rectosigmoid dilatation is not present.

Key words

anorectal junction - stenosis - Y‐V plasty - constipation

References

• 1 Chatterjee S K. Rare/regional variants. Holschneider AM, Hutson JM Anorectal Malformations in Children. Berlin; Springer-Verlag 2006: 251-262
• 2 Hamada Y, Mori T, Tanano A, Kato Y, Takada K, Sato M. et al . Anorectal stenosis in a neonate: report of a case and review of the Japanese literature.  Surg Today. 1996;  26 814-817
• 3 Hisato T, Yoshio K, Katsushi W, Yasuhiko I, Akira O. A case of ano-rectal stenosis treated with posterior sagittal anorectoplasty.  Journal of Japanese Society of Pediatric Surgeons. 1993;  29 1028-1033
• 4 Ladd W E, Gross R E. Congenital malformations of rectum and anus; report of 162 cases.  Am J Surg. 1934;  23 167-183
• 5 Mahomed A A, Driver C P, Nanthakumaran S. Congenital funnel anus: investigation and novel management strategy.  J Pediatr Surg. 2004;  39 119-121
• 6 Murphy F, Puri P, Hutson J M, Holschneider A M. Incidence and frequency of different types, and classification of anorectal malformations. Holschneider AM, Hutson JM Anorectal Malformations in Children. Berlin; Springer-Verlag 2006: 163-184
• 7 Nixon H H. Congenital deformities of the anorectal region. Goligher JC Surgery of the Anus, Rectum and Colon. 5th ed. London; Balliere Tindall 1984: 285-304
• 8 Rintala R J, Jarvinen N J. Congenital funnel anus.  J Pediatr Surg. 1996;  31 559-562
• 9 Stephens F D, Smith E D. Ano-Rectal Malformations in Children. Chicago; Yearbook Medical Publishers 1971
• 10 Stephens F D, Smith E D. Anorectal Malformations in Children: Update 1988. New York; Alan R. Liss, Inc. 1988
• 11 Stephens F D, Smith E D. Classification, identification and assessment of surgical treatment of anorectal anomalies.  Pediatr Surg Int. 1986;  1 200-205