The functional recovery of the newly formed anorectal apparatus in the high form of anal atresia in children

Abstract

Background. Physiologically, the anorectal switching device ensures the retention of the gas, liquid and solid content in different positions of the body, including during physical exertion, sneezing and coughing. The retention occurs due to the interaction of the rectum receiving apparatus, the nervous system, the smooth muscle of the locking device and the walls of the rectum. Under the influence of a number of pathological factors, the functional capacity of the unformed rectal apparatus is substantially compromised. Case report. In the following we present the clinical case of a patient, who was diagnosed with ARM (anorectal malformation) - high form of ano-rectal atresia, without associated fistula, with sacrococcygeal agenesis. At 72 hours after birth, after a preoperative preparation, was performed descendostoma with separate ends after A. Pena. At age of 3 months, abdominoperineal plastic reconstructive operation was performed, with neo-anus and neorectum formation, anterior and posterior levatoroplasty (puborectal strap formation), mAES sphincteroplasty (m. External anal sphincter). At age of 7 months, stoma was closed and the intestinal continuity was restored. The stage investigations indicate a satisfactory postoperativeresult, with the centered anal sphincter, the elastic anal ring, without stenosis, and maintaining muscle tonus. At the same time, the child present episodes of overfill encopresis and colostasis on the background of the dysmotility, caused by the caudal osteoneurogenic defect, with affecting of spinal nerve centers. Electrosphincterometry determines the bioelectric activity of the external anal sphincter muscle of the hypotone type, without signs of denervation. The anal canal profilometry at rest denotes a decrease of anal basal pressure. Profilometry in contraction, with vectorial projection of mAES denotes a symmetrical functional result in all quadrants, which shows that reconstructive proctoplasty has reached its goal in anatomical restoration of the defect, but the restoration of its function requires rehabilitation and individually tailored specialized stimulation treatment. During the time patient needed to dilate newly formed anal hole and canal, physio-kinetotherapeutic treatment, with balloon autotraining, biofeedback therapy, ultratonotherapy, perianal and sphincterian electrostimulation. Conclusions. High form ano-rectal atresia can be corrected by reconstructive surgery, but once the anatomical area is restored it needs to be "learned" to function according to normal physiology, this being possible through prolonged functional rehabilitation.