The Colorectal Quiz: Episode 1

VACTERL mnemonic stands for: V (vertebral abnormalities), A (anorectal malformations), C (cardiac abnormalities), E (esophageal atresia), R (renal abnormalities), and L (limb abnormalities)

Plain x-ray of the abdomen can identify vertebral abnormalities including hemivertebra in anorectal malformation workup

Cardiac evaluation should include both physical exam and echocardiogram in anorectal malformation patients

NG tube should be passed to rule out esophageal atresia in anorectal malformation workup

Kidney ultrasound is needed to evaluate for renal abnormalities in anorectal malformation patients

True sacral ratio measurements should wait until the child is three months of age

Pre-sacral mass is found almost half the time in anal stenosis or rectal atresia defects

Patients with pre-sacral mass in the setting of anorectal malformation will end up getting an MRI

Cross-table lateral radiograph is typically obtained at about the 24-hour mark to visualize the gas column location

For cross-table lateral, the baby is positioned prone with a bump under the buttocks to make the buttock the highest point where air will rise

Sacral ratio greater than 0.7 connotes a very good prognosis for bowel control

Well-formed buttock, good muscle, and true area where sphincter mechanism can be located, combined with well-developed sacrum, indicate likely good prognosis

The danger of posterior sagittal approach without knowing rectal location is finding something midline and white like the urethra, bladder neck, or bladder itself

Colostomy and distal colostogram are done to know exactly where the rectum is and whether to approach it perineally or laparoscopically

Colostomy carries its own complications, as does colostomy closure

If a primary anoplasty is performed without identifying a fistula, the child can start peeing out their anus postoperatively

During primary posterior sagittal approach, the posterior wall of the rectum should be opened and the anterior wall inspected to rule out fistula

In patients with low rectum, dissecting a little bit of the anterior wall and carefully lifting it off the urinary tract will usually rule out fistula

Bulbar fistula nomenclature refers to anatomic location at the elbow of the urethra

95% of Down syndrome patients with imperforate anus have no fistula, but 5% do have a fistula

Distal colostogram should still be performed in Down syndrome patients with anorectal malformation despite lower fistula prevalence