Pediatric Imperforate Anus Medication

  • Author: Nelson G Rosen, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Jan 25, 2010
 
 

Medication Summary

  • Many children with anorectal malformations require medications for various reasons. Beyond perioperative medications, maintenance medications often include urinary antibiotic prophylaxis or treatment and/or laxatives.
  • Urinary prophylaxis is used to mitigate the risk of urinary infection and urosepsis in children with risk factors for urinary infection such as urinary fistula, vesicoureteral reflux, or continent diversion. Common agents include oral amoxicillin, oral trimethoprim/sulfamethoxazole, and gentamicin bladder irrigations. Comprehensive information on all these medications and others is available in the eMedicine pediatric topic Urinary Tract Infection.
  • Common laxatives include senna products, milk of magnesia, and propylene glycol solutions (eg, MiraLax, GlycoLax).
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Nelson G Rosen, MD, FACS, FAAP  Assistant Professor of Surgery and Pediatrics, Albert Einstein College of Medicine; Attending Pediatric Surgeon and Director, Pediatric Trauma Center, Department of Pediatric General Surgery, Schneider Children's Hospital

Nelson G Rosen, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, American Trauma Society, Association of Military Surgeons of the US, Canadian Association of Pediatric Surgeons, and Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel A Beals, MD  Attending Staff, Cornerstone Pediatric Surgery

Daniel A Beals, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Surgical Association, American Society for Bioethics and Humanities, Kentucky Medical Association, Society for Fetal Urology, Society of Critical Care Medicine, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H  Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Bushnaq Medical Centre, University of Jordan

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons in Ireland, Royal College of Surgeons of Edinburgh, and Royal Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Pena A, Devries PA. Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg. Dec 1982;17(6):796-811. [Medline].

  2. Lee SC, Chun YS, Jung SE, et al. Currarino triad: anorectal malformation, sacral bony abnormality, and presacral mass--a review of 11 cases. J Pediatr Surg. Jan 1997;32(1):58-61. [Medline].

  3. [Guideline] Bischoff A, Levitt MA, Bauer C, Jackson L, Holder M, Pena A. Bowel management for fecal incontinence in patients with anorectal malformations. J Pediatr Surg. Jun 2009;44(6):1278-83. [Medline].

  4. Pena A. Anorectal malformations. Semin Pediatr Surg. Feb 1995;4(1):35-47. [Medline].

  5. Albanese CT, Jennings RW, Lopoo JB, et al. One-stage correction of high imperforate anus in the male neonate. J Pediatr Surg. May 1999;34(5):834-6. [Medline].

  6. Chait PG, Shandling B, Richards HM, Connolly BL. Fecal incontinence in children: treatment with percutaneous cecostomy tube placement--a prospective study. Radiology. Jun 1997;203(3):621-4. [Medline].

  7. Chatterjee SK. The value of inversion radiography (invertography) in the assessment of anorectal malformation. J Indian Med Assoc. Dec 16 1976;67(12):265-7. [Medline].

  8. De Filippo RE, Shaul DB, Harrison EA, et al. Neurogenic bladder in infants born with anorectal malformations: comparison with spinal and urologic status. J Pediatr Surg. May 1999;34(5):825-7; discussion 828. [Medline].

  9. [Guideline] Dick EA, Patel K, Owens CM, De Bruyn R. Spinal Ultrasound in Infants. Br J Radiol. April 2002;75:384-392. [Medline]. [Full Text].

  10. Flageole H, Fecteau A, Laberge JM, Guttman FM. Hirschsprung's disease, imperforate anus, and Down's syndrome: a case report. J Pediatr Surg. Jun 1996;31(6):759-60. [Medline].

  11. Fraser R. Imperforate anus: nutritional care. Paediatr Nurs. Apr 1996;8(3):16-8. [Medline].

  12. Georgeson KE, Inge TH, Albanese CT. Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique. J Pediatr Surg. Jun 2000;35(6):927-30; discussion 930-1. [Medline].

  13. Golonka NR, Haga LJ, Keating RP, et al. Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord. J Pediatr Surg. July 2002;37:966-969. [Medline].

  14. Heikenen JB, Werlin SL, Di Lorenzo C, et al. Colonic motility in children with repaired imperforate anus. Dig Dis Sci. Jul 1999;44(7):1288-92. [Medline].

  15. Hendren WH. Cloaca, the most severe degree of imperforate anus: experience with 195 cases. Ann Surg. Sep 1998;228(3):331-46. [Medline].

  16. Hong AR, Acuna MF, Pena A, et al. Urologic injuries associated with repair of anorectal malformations in male patients. J Pediatr Surg. Mar 2002;37(3):339-44. [Medline].

  17. Levitt MA, Patel M, Rodriguez G. The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg. 1997;32(3):462-8.

  18. Levitt MA, Patel M, Rodriguez G, et al. The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg. Mar 1997;32(3):462-8. [Medline].

  19. Levitt MA, Stein DM, Pena A. Gynecologic concerns in the treatment of teenagers with cloaca. J Pediatr Surg. Feb 1998;33(2):188-93. [Medline].

  20. Moss RL. The failed anoplasty: successful outcome after reoperative anoplasty and sigmoid resection. J Pediatr Surg. Jul 1998;33(7):1145-7; discussion 1147-8. [Medline].

  21. Nagar H, Weiss J, Kessler A. Bacterial orchitis in a baby with imperforate anus. Pediatr Radiol. Sep 1998;28(9):705. [Medline].

  22. Pena A. Total urogenital mobilization--an easier way to repair cloacas. J Pediatr Surg. 1997;32(2):263-8. [Medline].

  23. Pena A, Amroch D, Baeza C, et al. The effects of the posterior sagittal approach on rectal function (experimental study). J Pediatr Surg. Jun 1993;28(6):773-8. [Medline].

  24. Pena A, el Behery M. Megasigmoid: a source of pseudoincontinence in children with repaired anorectal malformations. J Pediatr Surg. Feb 1993;28(2):199-203. [Medline].

  25. Rich MA, Brock WA, Pena A. Spectrum of genitourinary malformations in patients with imperforate anus. Pediatric Surg Intl. 1988;3:110-113.

  26. Rosen NG, Hong A, Soffer S. Recto-vaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations. J Pediatr Surg. 2002;37(7):961-5.

  27. Shaul DB, Harrison EA. Classification of anorectal malformations--initial approach, diagnostic tests, and colostomy. Semin Pediatr Surg. Nov 1997;6(4):187-95. [Medline].

  28. Soffer SZ, Rosen NG, Hong AR, et al. Cloacal exstrophy: a unified management plan. J Pediatr Surg. Jun 2000;35(6):932-7. [Medline].

  29. Torres R, Levitt MA, Tovilla JM, Rodriguez G, Pena A. Anorectal malformations and Down's syndrome. J Pediatr Surg. Feb 1998;33(2):194-7. [Medline].

  30. Tsakayannis DE, Shamberger RC. Association of imperforate anus with occult spinal dysraphism. J Pediatr Surg. Jul 1995;30(7):1010-2. [Medline].

  31. Wang C, Lin J, Lim K. The use of augmented-pressure colostography in imperforate anus. Pediatr Surg Int. Jul 1997;12(5-6):383-5. [Medline].

 
Previous
Next
 
Distal colostogram, posteroanterior view. The initial phase of augmented-pressure distal colostography aims to determine where the colostomy was placed in the colon and how much colon is available for pull-through, without taking down the colostomy.
Distal colostogram, lateral view. This image shows the second phase of distal colostography, in which the patient is placed in the lateral position. A radio-opaque marker is clearly visible in the lower right side of the image, marking the muscle complex on the skin. This image shows that the rectal pouch joins the urinary tract at the level of the bulbar urethra, a relatively common malformation in boys.
Bucket-handle malformation. The appearance of a band of skin overlying the sphincteric muscle complex is a common sign in a child born with imperforate anus and perineal fistula.
String-of-pearls malformation. This image shows white mucoid material within a perineal fistula. The fistula frequently extends anteriorly up the scrotum's median raphe.
Cloaca. This is the classic appearance of a girl with a cloacal malformation with a single perineal orifice. The genitals appear quite short, which is a finding consistent with cloaca.
Fourchette fistula. This malformation is somewhere halfway between perineal fistula and vestibular fistula. The fistula has a wet vestibular mucosal lining on its anterior half, but the posterior half is dry perineal skin.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.