Attention of Vaginal Anomalies During the Posterosagittal Anorectoplasty

Year 2016, , 185 - 188, 01.09.2016

Vedat Akçaer Ayşenur Cerrah Celayir Neslihan Gülçin Dolunay Alver

https://doi.org/10.5505/abantmedj.2016.25901

Abstract

The incidence of urogenital anomaly associated with anorectal anomalies is very high. Two different types of vaginal anomaly associated with anorectal anomalies were presented in here. An 8 months old girl admitted to our department due to anal atresia with rectovestibular fistula. A rectosigmoid colostomy was created due to very narrow fistula. During the definitive operation, two vaginal orifices were seen; vaginal septum excision and vaginoplasty via posterosagital anorectoplasty were done. Another girl admitted to our department anal atresia with rectovestibuler fistula who had one year old. Calibration and dilatation of the fistula had been done until Hegar 15. Patient had been prepared for definitive operation without colostomy; but vaginal orifice was not found in perineal examination and a diverting sigmoid colostomy was created. Chromosomal analysis was found as 46 XX. Prediagnosis was vaginal atresia, because pelvic MR showed a suspicious imagination like an atrophic uterus. Vaginal orifice was absent at cystoscopy. Bifid uterus, right and left tubas, and right and left ovaries were seen at laparoscopy. A neovagina from rectovestibular fistula during the posterosagittal anorectoplasty was created in two years old, and three months later colostomy closed. In conclusion; girls with anorectal anomaly should be examined carefully at the first admission to determine the associated vaginal anomalies and to avoid surprises during the surgery.

Keywords

Vaginal anomaly, vaginal atresia, anorectal malformations, persistent cloaca, rectovestibular fistula.

Posterosagital Anorektoplasti Sırasında Vajinal Anomalilere Dikkat

Abstract

Anorektal anomalili olgularda eşlik eden ürogenital anomali insidansı oldukça yüksektir. Rektovaginal fistüllü anal atrezili iki olgumuzda farklı şekilde karşımız çıkan vaginal anomali nedeniyle anorektal anomalili kızlarda olası vaginal patolojilere dikkat çekmek amacıyla olgularımız sunuldu. Rektovestibuler fistüllü anal atrezi nedeniyle 8 aylıkken kliniğimize başvuran birinci olguda rektosigmoid kolostomi açıldı. Definitif ameliyatı sırasında iki vaginal orifis olduğu gözlendi. Posterosagittal anorektoplasti yapılırkenvaginal septum eksize edildi ve vaginoplasti gerçekleştirildi. Yenidoğan döneminde rektovestibuler fistüllü anal atrezi nedeniyle sol sigmoid kolostomi yapılan ikinci olguda definitif ameliyat sırasında vaginal orifis izlenmedi, ameliyata son verildi. Hastanın kromozom analizinde 46XX olduğu, Pelvik MRI incelemede atrofik uterus olabilecek şüpheli imaj olması nedeniyle vaginal atrezi ön tanısı konuldu. Hastaya 2 yaşında posterosagittal yaklaşımla mevcut rektovestibüler fistülden neovagina oluşturularak anorektovaginoplasti yapıldı. Sonuç olarak; rektovestibüler fistüllü anal atrezili kızlarda eşlik edebilecek vaginal anomaliler açısından hastanın ilk muayenesinde perinenin dikkatlice gözden geçirilmesi; definitif ameliyatlar sırasında vaginal anomali sürprizleriyle karşılaşılmasını azaltacaktır.

Keywords

Vaginal anomali, vaginal atrezi, anorektal malformasyonlar, kloaka anomalisi, rektovestibular fistül.

References

• Saravelos SH, Cocksedge KA, Tin-Chiu L. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Human Reproduction Update 2008; 14: 415- 29.
• Li S, Qayyum A, Coakley FV, Hricak H. Association of renal agenesis and mullerian duct anomalies. Journal of computer assisted tomography 2000; 24: 829-34.
• Heinonen PK. Complete septate uterus with longitudinal vaginal septum. Fertility and sterility 2006; 85: 700-5.
• Perez-Brayfield MR, Clarke HS, Pattaras JG. Complete bladder, urethral, and vaginal duplication in a 50-year-old woman. Urology 2002; 60: 514.
• Holschneider A, Hutson J, Pena A, et al. Preliminary report on the interınational conference for the developıment of standards for the treatment of anorectal malformations. J Pediatr Surg 2005; 40: 1521- 6.
• Moazam F, Talbert JL. Congenital anorectal malformations. Arch Surg 1985;120: 858-9.
• Nievelstein RA, Vos A, Valk J. MR imaging of anorectal malformations and associated anomalies. Eur Radiol 1998; 8(4): 573-81.
• Shaul DB, Harrison EA. Classification of anorectal malformations-initial approach, diagnostic tests and colostomy. Semin Pediatr Surg 1997; 6: 187-95.