Photographic Album of Anorectal Malformations and the Sphincter Muscles

F. Douglas Stephens

The specimens presented in the accompanying compact disc were collected and sectioned at the Royal Children's Hospital, Melbourne, Australia and the Children's Memorial Hospital, Chicago, USA. The colored sections were enlarged directly from the stained histologic sections, which were selected from serial sections of the pelvis of newborn babies who had died of multiple anomalies. The sections show the normal and abnormal anatomy of the viscera and the muscular components of the levator ani and sphincter muscles of the anorectum. Kascot Media Incorporated (Chicago, Illinois, USA) rephotographed the Cibachromes and diagrams and arranged the layout in the original atlas.

The prints have been traced and colored. The schematic diagrams are color-coded: yellow for urinary structures, green for smooth muscle of the bowel, red for the levator complex, brown for external sphincter muscle, purple for genital organs, and blue for cartilage. The red spots on the schematic diagrams serve to orient the sections of each specimen. The blue dots on some diagrams indicate the course of a fistula or bowel lumen.

"P-C" represents the pubococcygeal line, which is drawn on a true lateral radiograph between the center of the boomerang-shaped ossific center of the pubic bone through the junction of the cranial one-quar-

Table 6.1 Index of anomalies ter and the caudal three-quarters of the ischial ossific center, and a point just distal to the ossific center of the fifth sacral vertebra.

The 1984 classification of ARM is the first illustration (Table 6.1, Fig. 6.1). Figure numbers 6.2-6.28 show female anomalies and 6.29-6.55 show male anomalies. Tables 6.2 and 6.3 list the malformations in females and males with corresponding Figure numbers.

Table 6.2 Female malformations with Figure number

Malformation

Figures

Normal female pelvis

6.2-6.3

Normal female pelvis

6.4-6.5

Rectovesical fistula (with phallic urethra)

6.6-6.8

Rectovestibular/low cloaca (absent vagina)

6.9-6.12

Cloaca with short common channel (atrophic vagina)

6.13-6.15

Anorectal atresia

6.16-6.18

Anovestibular fistula

6.19-6.20

Anterior Anus (slightly oblique transverse section)

6.21-6.22

Anocutaneous fistula

6.23-6.25

Perineal groove

6.26-6.28

Table 6.3 Male malformations with Figure number

Table 6.1 Index of anomalies

Index of Anomalies

Anomaly: female

• Normal female

1F, 2F

• High anomaly

3F

• Intermediate anomalies

4-6F

• Low anomalies

7-10F

Anomaly: male

• Normal male

1M

• High anomaly

2M

• Intermediate anomalies

3-5M

• Low anomalies

6-10M

Table 6.3 Male malformations with Figure number

Malformation

Figures

Normal male pelvis

6.29-

6.30

Rectoprostatic urethral fistula

6.31-

6.33

Rectobulbar urethral fistula (paremedian)

6.34-

6.35

Rectobulbar fistula

6.36-

6.38

Rectobulbar fistula (A+B)

6.39-

6.40

Anocutaneous fistula

6.41-

6.43

Anocutaneous fistula

6.44-

6.45

Anocutaneous fistula (bucket handle)

6.46-

6.48

Anocutaneous fistula

6.49-

6.51

Imperforate anal membrane

6.52-

6.55

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Anorectal MalformationMalformation AnorectaleOssific Centers Bucket Handle Malformation
Anorectal MalformationAnorectal MalformationAnorectal Malformation
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hViStle.

Anorectal Malformation

fttc.VûU£.i i cjo.\ Fοtola. (.Phalli*. Drfc&Vra!) Ç

Anorectal Malformation

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Fig. 6.9 Rectovestibular or low rectocloacal fistula (absent vagina) (4F.1)

4F.2

Rectovestibular Fistula
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