Diagnostic Accuracy of Sonography for Detection of a Fistula on the Birth Day in Neonates With an Imperforate Anus: Comparison of Diagnostic Performance Between Suprapubic and Perineal Approaches

Abstract

The diagnostic accuracy of sonography for detection of an internal fistula on the birth day exceeded 75% in neonates with an imperforate anus, and sonography on the birth day is feasible. The perineal approach had superior diagnostic performance over the suprapubic approach. Thus, when evaluating an internal fistula by sonography, we recommend using the perineal approach in addition to the suprapubic approach.

Sonographic detection and localization of fistulas in fetuses with imperforate anus: Case reports

“…Fistulas in the fetuses were demonstrated as a hyperechoic linear structure. Meanwhile, fistulas in our neonates were visualized as a hypoechoic tubular tract between hyperechoic thin walls, as previously reported 11–14 . A fistula in cases of IA consists of a cavity and walls, which in neonates, are visualized as a hypoechoic tubular tract and hyperechoic thin walls, respectively.…”

“…Therefore, the evaluation of fistulas enhances the accuracy of the classification of IA. Sonography using a high‐frequency transducer is now favored for the evaluation of fistulas after birth because of its high accuracy and absence of radiation exposure 11–14 . More than 75% of fistulas can be correctly assessed neonatally using transabdominal and transperineal ultrasonography 13 .…”

“…Sonography using a high‐frequency transducer is now favored for the evaluation of fistulas after birth because of its high accuracy and absence of radiation exposure 11–14 . More than 75% of fistulas can be correctly assessed neonatally using transabdominal and transperineal ultrasonography 13 . However, no studies have focused on the assessment of fistulas in fetuses with IA.…”

Comparison Between the Pouch‐Perineum Distance in Neonates With a Low‐Type Anorectal Malformation With and Without an Opened Fistula: Pitfall of Measuring the Pouch‐Perineum Distance on Sonography

“…For neonates with an opened fistula and a pouch-perineal distance greater than 10 mm, an augmented pressured colostogram can be useful for correct diagnosis. 3 Although previous studies have demonstrated the utility of sonography for classifying the type of ARM, [8][9][10][11][12]17,19,20 to our knowledge, ours is the first study to have evaluated the possible effect of an opened fistula on the measured pouch-perineum distance. The longer pouch-perineum distance in neonates with the low-type ARM with an opened fistula might be due to the early passage of meconium passed through the fistula, which decompresses the distal rectal pouch, prolonging the pouch-perineum distance (Figure 3).…”

“…22 Sonography is useful not only to evaluate the pouchperineum distance but also to evaluate the relationship between the puborectalis muscle and the distal rectal pouch, which is reported to be useful to classify the type of ARM. 10,17,19,20 Furthermore, sonography can be also used to assess other accompanying anomalies and assist with the surgical procedure. 12 Therefore, sonography is recommended as an evaluative and diagnostic tool for neonates with an ARM.…”