Anorectal malformations and perineal hemangiomas: The Arm-Net Consortium experience

Research output: Contribution to journalArticle

Abstract

Aim: Perineal hemangiomas rarely occur in patients with anorectal malformations (ARMs), but they can pose a significant challenge and warrant special attention. Surgical incision of posterior sagittal anorectoplasty (PSARP) may involve the hemangioma site resulting in hemorrhage, damage to blood supply, leading to complications and adversely affecting outcome. The aim of this study was to review the experience of the ARM-Net Consortium in the management of perineal hemangioma associated with ARM and evaluate treatment strategies. Materials and methods: Data on all patients with ARM and a perineal hemangioma located in the planes of the PSARP dissection who were managed at participating ARM-Net centers were collected retrospectively by questionnaire, as follows: ARM type, hemangioma distribution and penetration, imaging findings, medical/surgical management, timing of definitive repair, complications and outcome. Results: Ten patients from eight centers were included. Three patients each had a rectobulbar or rectovestibular fistula, 2 had a rectoperineal fistula, and one had a rectoprostatic fistula; in one patient, the hemangioma was too disfiguring to determine malformation type. Mean follow-up time was 36.6 months (median 29 months). Colostomies were performed before definitive repair in 8 patients. Five patients received systemic beta-blockers before PSARP: 3 were operated uneventfully following partial/complete involution of the hemangioma, and 2 are awaiting surgery. The two patients with rectoperineal fistula were managed expectantly. The remaining 3 patients underwent surgery with no preoperative medical treatment, and all had complications: mislocated neoanus in three and complete perineal dehiscence in one. Conclusion: Attempting PSARP in the presence of a perineal hemangioma may lead to complications and adversely affect outcome. This study confirms the benefits of beta blocker treatment before surgical reconstruction. Level of evidence: Treatment study, level III.

Details

Authors
  • Inbal Samuk
  • Carlos Gine
  • Ivo de Blaauw
  • Anna Morandi
  • Pernilla Stenstrom
  • Stefano Giuliani
  • Gabriele Lisi
  • Paola Midrio
Organisations
External organisations
  • Tel-Aviv University
  • Vall d'Hebron University Hospital
  • Maggiore Hospital Policlinico
  • Skåne University Hospital
  • Radboud University Medical Center
  • Great Ormond Street Hospital for Children NHS Foundation Trust
  • University of Chieti-Pescara
  • Civic Hospital Of Pescara
  • Treviso Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Pediatrics
  • Surgery

Keywords

  • Anorectal malformations, Anorectoplasty, Anus, Beta-blockers, Hemangioma, Imperforate
Original languageEnglish
JournalJournal of Pediatric Surgery
Publication statusE-pub ahead of print - 2018 Dec 29
Publication categoryResearch
Peer-reviewedYes