The Colorectal Quiz: Episode 1

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

Plain x-ray of the abdomen can identify vertebral abnormalities including hemivertebra

Cardiac workup should include both physical exam and echocardiogram

NG tube should be passed to rule out esophageal atresia

Kidney ultrasound is needed to evaluate for renal abnormalities

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

Pre-sacral masses are rare in typical imperforate anus cases

In anal stenosis or rectal atresia defects, pre-sacral mass is found almost half the time

Patients with pre-sacral mass will need MRI

Cross-table lateral radiograph should be obtained at about 24 hours of life, give or take a few hours

For cross-table lateral, baby is positioned prone with buttock at highest point where air will rise to

Cross-table lateral can be obtained at bedside in neonatal unit by placing baby on bump under buttocks

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

Well-formed buttock, good muscle, and true area where sphincter mechanism can be located indicate likely good prognosis

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

Colostomy and distal colostogram allow knowing exactly where rectum is and whether to approach perineally or laparoscopically

Colostomy carries its own complications, as does colostomy closure

If fistula is ignored during primary anaplasty, child can start peeing out their anus postoperatively

During primary repair, opening posterior wall of rectum and inspecting anterior wall can rule out fistula in low rectum cases

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 to rule out the 5% who have fistula