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Transperineal Sonography for Determination of the Type of Imperforate Anus

¹ Department of Pediatric Radiology, University of Tübingen, Hoppe-Seyler-Str. 1, D-72076 Tübingen, Germany.
² Department of Pediatric Surgery, University Children's Hospital, Tübingen, Germany.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —1-day-old boy with imperforate anus. Photograph shows placement of linear transducer for transperineal sonographic examination.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —1-day-old boy with low imperforate anus without fistula. Midline sagittal sonogram shows 5-mm distance (asterisks, dashed line) between distal rectal pouch and perineum (P). Scale segment distance, 2 mm. S = pubic symphysis, U = urethra (arrow), CS = corpus spongiosum.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —6-day-old girl with intermediate imperforate anus and rectovestibular fistula. Midline sagittal sonogram shows relation between small fistula (arrow) and posterior wall of vagina. Distance (asterisks, dashed line) between distal rectal pouch and perineum (P) is 17 mm. Scale segment distance, 5 mm. S = pubic symphysis, U = urethra (arrow), V = vestibule of vagina (arrow), P = perineum.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —1-day-old boy with high imperforate anus and small rectourethral fistula (arrow). Midline sagittal sonogram shows distance (asterisks, dashed line) between distal rectal pouch and perineum is 22 mm. Scale segment distance, 2 mm. S = pubic symphysis, U = urethra, CS = corpus spongiosum.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Scattergram shows distance (mean ± SD) between distal rectal pouch and perineum measured on transperineal sonography in infants with low, intermediate, and high imperforate anus. Dotted line indicates cutoff distance of 15 mm. Black dots indicate data for infants with internal or anocutaneous fistula; white dots, data for infants without internal or anocutaneous fistula.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —28-day-old girl with low mimicking high imperforate anus. Midline sagittal sonogram shows gas-filled distal rectal pouch decompressed by large anocutaneous fistula (arrowheads). Distal end of pouch is difficult to delineate and pouch-to-peritoneum (P) distance (asterisks) is more than 15 mm, fulfilling criterion for high anomaly. In general, anocutaneous fistula indicates low anomaly, making pouch-to-peritoneum measurements unnecessary. S = pubic symphysis, V = vagina.

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