1. Case presentation: The patient was a 71-year-old woman who was referred to the general surgery clinic due to a severe colonic dilatation and a fecal mass that was found in her abdominopelvic CT scan, which was ordered by a nephrologist for approaching her right flank pain. The patient had experienced bloating and progressive abdominal distension in the year prior to the current visit. The last defecation had occurred approximately 20 days prior to the visit, and the last gas passage had occurred the day before the visit...

Introduction: Mild anterior displacement of the anus may be a cause of constipation. Routinely for detection of the anterior anus, the mean anal position index is used but in this study we introduce another modality for this purpose.Material and Methods: In this prospective study, patients with intractable constipation with onset bellow one year of age, normal rectal manometry, normal rectal biopsy and abnormal shape of anal verge, were include. The location of the anus was checked by muscle stimulator and according to the severity of the anteriority mini anorectoplasty or simpleY-V transposition of the anus was performed.Results: Ten patients were studied. All were female with a mean age of 7 months. In 2 cases anorectoplasty and in the others Y-V anoplasty was done. All patients ultimately were cured.Conclusion: Using muscle stimulator in external sphincter is reliable for detection of anterior displacement of the anus. Anorectoplasty or Y-V anoplasty for resolving constipation in these patients are effective.

Background and Objectives: Optimal surgical management of the neonate with imperforate anus depends on accurate determination of the level of the rectal pouch. The use of ultrasound to determine the pouch level has been previously described, but has not become widely accepted. The goal of this study is to determine the validity of this measurement according to final surgical findings in patients with anorectal malformation. Materials and Methods: In a cross sectional study,23 children with imperfo-rated anus were evaluated by transperineal ultrasound with a 7.5 MHz sector transducer in the supine and lithotomic positions to determine the pouch level and pouch to perineum (P-P) distance. In all cases, the level of the distal pouch was confirmed by definitive surgery or distal colostogram. The agreement between sonography and surgery or colostogram as gold standard was obtained by weighted kappa test. Results: In five children, the pouch to perineum (P-P) distance was less than 10mm. All of these low lesions were safely treated by a simple perineal anoplasty (minimal posterior sagittal anorectoplasty; i.e. minimal PSARP) and were confirmed as low type. Seven children had P-P distance of 10-15 mm. In the follow up definitive surgery, 5 cases were intermediate and two cases were high. Eleven children had a P-P distance of more than 15 mm, of which ten cases were high lesions and had colostomy at birth. During follow up, 8 cases underwent definitive surgery of PSARP and two of these high cases were confirmed by distal colostogram and one case was categorized as intermediate by definitive PSARP. Measure of agreement (Kappa) was calculated to be 0.791 (P = 0.001) Therefore, Ultrasound correctly predicted the level of the distal pouch in 20 of 23 patients.Conclusion: Transperineal ultrasound can be confidently used prior to surgical decision in children with imperforate anus in addition to physical exam.

Aone-day-old neonatal boy was admitted to the hospital to evaluate his imperforate anus. He was born prematurely (at 36 weeks of gestation) via normal vaginal delivery. He was the second child of non-consanguineous parents. The other sibling was healthy. The neonatal period had been uneventful...

Objectives: The present study aimed to investigate the efficacy of the ultrasound-guided wire localization of the anal tract and sphincter muscle complex in the patients with imperforate anus.Methods: This study was conducted on 20 patients (4 females and 16 males) with imperforate anus referring to the Doctor Sheikh and Akbar Pediatric Hospitals, Mashhad, Iran, between2016 and 2017. The trans-perineal ultrasonography was performed under general anesthesia to identify the location and direction of the anal tract, which was checked by a muscle stimulator. Then, the localization needle was inserted in the center of the anal pit and anal sphincter muscle complex until it reached the rectal pouch.Eventually, by using the wire as a guide, the rectum was brought to the middle of the sphincter complex through the minimally invasive pull-through procedure.Results: The anal sphincter muscle complex (concentric hypoechoic muscle) could be seen in all patients with the thickness of 1.8 -3.6mmand mean of 2.6mm. The anal pit (the multi-layer view) was visualized in all patients, except in two cases with clinically lowtype imperforate anus. Muscle stimulator findings showed that the wire was located in the middle of the sphincter muscle complex in all patients. Mean localization time was 38 min.Conclusions: The ultra sound-guided wire localization of the anal tract facilitated the implementation of a less invasive and anatomically corrected rectal pull-through operation in patients with imperforate anus.

Background and Aims: Various methods are used for treatment of open bite. The objective of this study was to investigate the effects of Lower Anterior High Pull Headgear (LAHPH) appliance in Class I subjects with moderate open bite and high lower lip line.Materials and Methods: The study group was composed of 10 subjects with a mean age of 15.8±2.5 years and 3.05±0.07 mm moderate open bite. All the patients rejected or thognathic surgery. The treatment included extraction of upper and lower second premolars followed by leveling, banding, bonding, posterior space closure, and anterior retraction. After these procedures, the open bite was reduced to 2.04±1.17 mm. afterwards; LAHPH was applied for 18 hours per day for 8±2 months. LAHPH appliance was composed of High Pull Headgear and two hooks mounted on its inner bow. Two elastics (1.8, light, Dentaurum) connected the upper hooks on the inner bow to the lower hooks on the mandibular canines vertically. The forces produced by the prescribed elastics were 10 and 60 g during mouth closing and opening, respectively. Paired T-test was used to evaluate pre-and post-treatment outcomes.Results: The pre-and post-treatment cephalometric evaluations showed that the LAHPH reduced effectively the open bite of the patients to 0.15±1.7 mm (P<0.001).Conclusion: This appliance can be used as an acceptable method for closing the open bite in Class I subjects.

Background: Fecal incontinence is one of the secondary and serious complications following anorectoplasty operation in the children with Imperforated Anus. Complete rectal dislocation and local spinal defect of the sphincter muscle are the main causes of fecal incontinence in people undergoing surgery for Imperforated Anus. Methods: This retrospective descriptive Case-Series study was performed during 2015 to 2020 at Maryam hospital. Data were collected by a checklist that was designed by the research. The collected data were analyzed by SPSS software version 23. Descriptive analysis was used to analyze the qualitative variables while quantitative variables were summarized using mean and , Standard Deviation (±, SD). Results: The mean age of patients was 9. 65 years and the standard deviation ( ±, SD) was 7. 45 (2-33 years). Fecal incontinence is the most common side effect after Sphincteroplasty for treatment of "Imperforated Anus" following anorectoplasty. The success rate of surgery in this study in the recovery of patients with fecal incontinence after anorectoplasty for patients with imperforated anus is 74% after 6 months and 89% after 2 years. Conclusion: The most common causes of fecal incontinence following anorectoplasty were rectal displacement as well as ano-rectum misplacement between the sphincter muscle and annular sphincter defect. In patients with history of anorectoplasty, annular sphincter defects were most often seen at rejoins 12 and 6 o'clock (Superior and Inferior). It is necessary that surgeons pay more attention to repairing these points in order to prevent the incidence and recurrence of fecal incontinence.

Congenital pouch colon (CPC) is an unusual condition in imperforate anus (IA), usually of high variety. This malformation is mostly reported from India, where it comprises about 7% of all anorectal malformations. In this anomaly, the normal colon is very short or absent and is replaced by a pouch like dilatation that usually communicates through a fistula with genitourinary tract or persistent cloaca. We are reporting on three cases of newborns (2 females, and 1 male) with this anomaly diagnosed during September 2001 to September 2004. These three cases comprise less than 3% of all cases of IA during this time period. The two girls had anorectal agenesia, short segment of colon and a pouch with vaginal fistula and persistent cloaca (Type II). Colon in the third case was replaced by a dilated pouch that communicated with a wide fistula to the bladder (Type I). This is very important for pediatric surgeons to be aware of the features of this condition to allow for proper diagnosis and surgical management.