Postoperative Pelvic MRI of Anorectal Malformations
Mohamed A. Eltomey1,
Lane F. Donnelly2,
Kathleen H. Emery2,
Marc A. Levitt3 and
Alberto Peña3
1 Department of Radiology and Imaging, Medical Compound, Faculty of Medicine,
Tanta University, Elbahr St., Tanta, Egypt 31511.
2 Department of Radiology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH.
3 Colorectal Center, Division of Pediatric Surgery, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH.
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Fig. 1A —5-year-old boy with normal sphincter and pelvic muscles.
Coronal T2-weighted MR image of pelvis shows pelvic floor muscles
(arrows) with shape of inverted umbrella and rectal ampulla resting
over it. Structure of voluntary muscles (arrowheads) surrounding anal
canal is evident.
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Fig. 1C —5-year-old boy with normal sphincter and pelvic muscles.
Axial T2-weighted MR image of pelvis at level of inferior pubic ramus shows
sphincter around anal canal (arrows) and transverse superficial
perineal muscles (arrowheads).
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Fig. 3A —3-year-old girl with poorly developed sphincter muscles after
repair of cloacal anomaly. Axial T2-weighted MR image of pelvis shows absence
of sphincter mechanism, denoting its poor development on both sides
(arrowheads). Asterisk indicates Foley catheter within lumen of
bowel.
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Fig. 3B —3-year-old girl with poorly developed sphincter muscles after
repair of cloacal anomaly. Coronal T2-weighted MR image shows bilateral poor
delineation of pelvic floor muscles (arrows) and thinning of
sphincter mechanism.
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Fig. 4A —5-month-old boy with asymmetric sphincter muscles after
repair of high anorectal anomaly (rectoprostatic fistula). Axial T1-weighted
MR image of pelvis shows fair development and asymmetry of sphincter mechanism
(arrows), which is thicker on left side compared with right. Rectum
is located centrally within sphincter.
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Fig. 4B —5-month-old boy with asymmetric sphincter muscles after
repair of high anorectal anomaly (rectoprostatic fistula). Coronal T2-weighted
MR image of pelvis shows fair development of sphincter muscles
(arrowheads).
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Fig. 5A —8-year-old boy with eccentric location of bowel after repair
of high anorectal anomaly (rectal–bladder neck fistula). Axial
T1-weighted MR image of pelvis shows irregular shape and asymmetry of
sphincter muscle (arrow). Rectum has eccentric location
(arrowhead) to left side of sphincter.
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Fig. 5B —8-year-old boy with eccentric location of bowel after repair
of high anorectal anomaly (rectal–bladder neck fistula). Coronal
T2-weighted MR image of pelvis and lower abdomen shows poorly developed
irregular and asymmetric muscles (arrow) and eccentric location
(arrowhead) of rectum.
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Fig. 6A —6-year-old boy with misplacement of bowel through sphincter
after repair of high anorectal anomaly. Axial T2-weighted MR image of pelvis
shows fairly well developed and asymmetric sphincter, which is thicker on left
side (arrow). Rectum is posterior and to right of sphincter muscle
(arrowhead) at this level.
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Fig. 6B —6-year-old boy with misplacement of bowel through sphincter
after repair of high anorectal anomaly. Axial T2-weighted MR image of pelvis
at level of inferior pubic ramus shows fairly developed sphincter
(arrow). Anal canal (arrowhead) is situated eccentrically to
right and anterior to sphincter at this level.
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Fig. 7A —33-year-old man with anteriorly and laterally misplaced bowel
after repair of high anorectal anomaly. Axial T1-weighted MR image of pelvis
shows poorly developed sphincter (arrow). Anal canal is anterior and
to left of muscle (arrowhead). Fatty infiltration of gluteal muscles
is present on both sides.
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Fig. 7B —33-year-old man with anteriorly and laterally misplaced bowel
after repair of high anorectal anomaly. Sagittal T1-weighted MR image of
pelvis shows poorly developed sphincter (arrow) and anal canal
anterior to sphincter. Catheter in bowel lumen facilitates visualization of
lumen.
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Fig. 8 —10-year-old boy with pulled-through fat after repair of high
anorectal anomaly. Axial T1-weighted MR image of pelvis shows fairly developed
and asymmetric sphincter muscles. Rectum is in central location within
sphincter with fat visible as area of high signal intensity (arrows)
around sphincter.
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Fig. 9 —2-year-old boy with pulled-through fat after repair of high
anorectal anomaly. Axial T1-weighted MR image of pelvis shows fairly developed
symmetric sphincter. Rectum is central within pelvis with fat
(arrows) circumferentially surrounding it.
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Fig. 10A —3-year-old boy with posterior urethral diverticulum after
repair of high anorectal anomaly (rectoprostatic fistula). Sagittal
T1-weighted MR image of pelvis shows large hypointense masslike lesion
posterior to bladder and anterior to rectum. Dysplastic shape of sacrum is
evident.
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Fig. 10B —3-year-old boy with posterior urethral diverticulum after
repair of high anorectal anomaly (rectoprostatic fistula). Axial T1-weighted
MR image shows well-defined hypointense masslike lesion (arrow)
displacing rectum to right. Lesion was proved at surgery to be posterior
urethral diverticulum (former distal rectum attached to urethra) related to
inadequate initial resection. Asterisk indicates Foley catheter within bowel
lumen.
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Fig. 11A —16-year-old boy with posterior urethral diverticulum after
repair of high anorectal anomaly (rectoprostatic fistula). Sagittal
T1-weighted MR image of pelvis shows isointense masslike lesion
(arrow) posterior to bladder neck and anterior to rectum.
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Fig. 11B —16-year-old boy with posterior urethral diverticulum after
repair of high anorectal anomaly (rectoprostatic fistula). Axial T2-weighted
MR image at level of prostate shows well-defined isointense to slightly
hyperintense masslike lesion (arrow) posterior to prostate and
anterior to rectum. Mass displaces rectum laterally to left. Lesion was proven
at surgery to be posterior urethral diverticulum (former distal rectum
attached to urethra) related to inadequate initial resection.
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Fig. 12A —5-month-old boy with small posterior urethral diverticulum
manifesting as acquired atresia of anus after repair of high anorectal anomaly
(rectoprostatic fistula). Sagittal T2-weighted MR image of pelvis shows subtle
irregularity in posterior aspect of prostatic urethra (arrow).
Well-developed sphincter and absence of segments of sacrum are evident.
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Fig. 12B —5-month-old boy with small posterior urethral diverticulum
manifesting as acquired atresia of anus after repair of high anorectal anomaly
(rectoprostatic fistula). Voiding cystourethrogram shows diverticulum-shaped
area (arrow) of prostatic urethra corresponding to irregularity in
A. Surgery revealed posterior urethral diverticulum related to
inadequate initial repair.
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Fig. 13 —5-year-old girl with dribbling of urine and incontinence due
to acquired fistula after repair of cloacal anomaly. Axial T2-weighted MR
image of pelvis shows linear area of high signal intensity representing
fistula between urethra and vagina, which is filled with urine
(arrow). Asymmetry of sphincter complex and displacement of rectum to
right side (arrowhead) are evident. Surgery revealed acquired fistula
related to inadequate initial repair. Asterisk indicates Foley catheter within
bowel lumen.
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Fig. 14A —18-month-old boy with missed presacral mass after repair of
rectal stenosis. Sagittal T1-weighted (A) and axial T2-weighted
(B) MR images show sacrum missing last segment. Oval mass
(arrow) at tip of sacrum is isointense in A and hyperintense
in B. Mass was surgically removed and proven to be teratoma. Dysplastic
shape of sacrum is evident in A.
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Fig. 14B —18-month-old boy with missed presacral mass after repair of
rectal stenosis. Sagittal T1-weighted (A) and axial T2-weighted
(B) MR images show sacrum missing last segment. Oval mass
(arrow) at tip of sacrum is isointense in A and hyperintense
in B. Mass was surgically removed and proven to be teratoma. Dysplastic
shape of sacrum is evident in A.
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Fig. 15 —4-year-old girl with multiple genitourinary anomalies after
repair of cloacal anomaly. Axial T2-weighted MR image of pelvis shows two
hemivaginas (arrowheads) with retained fluid (hydrocolpos).
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Fig. 16 —4-year-old boy with multiple genitourinary anomalies after
repair of high anorectal anomaly (rectal–bladder neck fistula). Axial
T2-weighted MR image of pelvis shows left hemibladder (arrow) and
right undescended testis (arrowhead). Fairly developed sphincter
mechanism and eccentric location of rectum on left side in relation to
sphincter are evident. Asterisk indicates Foley catheter within bowel
lumen.
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Copyright © 2008 by the American Roentgen Ray Society.
