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The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position
The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformat...
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| Published in: | Journal of pediatric surgery 2018-08, Vol.53 (8), p.1560-1565 |
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| creator | Patel, Jigar N. Kumar, Amit Yadav, Partap Singh Chadha, Rajiv Datta, Vikram Roy Choudhury, Subhasis |
| description | The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformations (ARM), using the center of the midline anal dimple (AD) to represent the center of the proposed neoanus, was performed to assess whether or not the AD was located in a significantly abnormal position as correlated with the normal anal position.
The cases comprised 65 consecutive newborn and infants with ARM, divided into 2 age-based groups (Group A: 1st day to 1month; Group B: 1–12months), without sacral or significant perineal abnormalities. Controls included an equal number of age and gender matched patients admitted for other conditions. The characteristics of the AD (‘well developed’ or ‘moderately developed’) as well as those of the midline perineal raphé in males and the perineal groove in females were also recorded.
Combining both age groups, the mean API±SD was 0.41±0.012 in male cases and 0.53±0.07 in male controls (p value 0.003). The corresponding values for female cases and controls were 0.31±0.09 and 0.36±0.07 respectively (p = 0.040). In male newborns, the API in cases was significantly lower than the API in controls (p |
| doi_str_mv | 10.1016/j.jpedsurg.2017.11.043 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1976007416</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022346817307637</els_id><sourcerecordid>1976007416</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-a7c1f02f2da4ff2f8620349d0337b7f96b2ad80e8e6313e6516c99f9ef6cfe7d3</originalsourceid><addsrcrecordid>eNqFkUFv1DAQhS0EokvhL1Q5ckmYsbNOcgNVFJAqcSlny2uPqVeJHewsFX-A341Ddrlysubpe_PkeYzdIDQIKN8dm-NMNp_S94YDdg1iA614xna4F1jvQXTP2Q6A81q0sr9ir3I-AhQZ8CW74gPnQ9vvd-z3wyNVc8x-8TFU0VVLmXXQY2X9NI9U-VAFejrEFHLRbZmdDkuunvzyWISYyCyFnvToYpr0uuYMFsjElGj8K26GdXtYuXELuSS_Zi-cHjO9Ob_X7Nvdx4fbz_X9109fbj_c10bIfql1Z9ABd9zq1jnueslBtIMFIbpD5wZ54Nr2QD1JgYLkHqUZBjeQk8ZRZ8U1e7vtnVP8caK8qMlnQ-OoA8VTVjh0EqBrURZUbqhJMedETs3JTzr9Ughq7UAd1aUDtXagEFXpoBhvzhmnw0T2n-1y9AK83wAqP_3pKalsPAVD1q_XVDb6_2X8Ad6-nvI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1976007416</pqid></control><display><type>article</type><title>The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position</title><source>ScienceDirect Journals</source><creator>Patel, Jigar N. ; Kumar, Amit ; Yadav, Partap Singh ; Chadha, Rajiv ; Datta, Vikram ; Roy Choudhury, Subhasis</creator><creatorcontrib>Patel, Jigar N. ; Kumar, Amit ; Yadav, Partap Singh ; Chadha, Rajiv ; Datta, Vikram ; Roy Choudhury, Subhasis</creatorcontrib><description>The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformations (ARM), using the center of the midline anal dimple (AD) to represent the center of the proposed neoanus, was performed to assess whether or not the AD was located in a significantly abnormal position as correlated with the normal anal position.
The cases comprised 65 consecutive newborn and infants with ARM, divided into 2 age-based groups (Group A: 1st day to 1month; Group B: 1–12months), without sacral or significant perineal abnormalities. Controls included an equal number of age and gender matched patients admitted for other conditions. The characteristics of the AD (‘well developed’ or ‘moderately developed’) as well as those of the midline perineal raphé in males and the perineal groove in females were also recorded.
Combining both age groups, the mean API±SD was 0.41±0.012 in male cases and 0.53±0.07 in male controls (p value 0.003). The corresponding values for female cases and controls were 0.31±0.09 and 0.36±0.07 respectively (p = 0.040). In male newborns, the API in cases was significantly lower than the API in controls (p<0.001). Combining both males and female newborns, the differences between the API in cases and controls was also statistically significant (p<0.001). In older boys as well as in girls from both age groups, apart from cases of persistent cloaca, the API was lower in cases than in controls, especially in boys, although the difference was not statistically significant. On comparing the API in individual male ARM with that in male controls, cases of rectobulbar urethral fistula (RBUF) and rectovesical fistula had a statistically significant lower API (p<0.001). In the 4 cases of persistent cloaca, the mean API (0.40±0.1) was higher than the mean API in female controls and the AD was well developed with a well-delineated, narrow perineal groove. The majority (53/65; 81.53%) of patients had a ‘well developed’ AD. Twelve patients (18.47%) had a ‘moderately developed’ AD including 10 females and 2 males. There were 15 patients with a depressed AD (anal fossette); of these 12 (80%) were females. All boys had a well delineated perineal raphé in contrast to 10 girls (29.4% of total female ARM) who had a poorly delineated midline perineal groove.
During definitive surgery for ARM, if the AD is taken as the site of the proposed neoanus, the neoanal position is likely to be anterior to the normal anal position in both males and females and especially so in males. Overall, girls with ARM appear to be more likely to have a relatively poorly developed and/ or depressed AD and a poorly delineated perineal groove.
Clinical Research.
Level III.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2017.11.043</identifier><identifier>PMID: 29229485</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anal Canal - abnormalities ; Anal Canal - anatomy & histology ; Anal dimple ; Anal position index ; Anorectal malformation ; Anorectal Malformations - diagnosis ; Cloaca ; Congenital pouch colon ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Perineum - abnormalities ; Perineum - anatomy & histology ; Prospective Studies</subject><ispartof>Journal of pediatric surgery, 2018-08, Vol.53 (8), p.1560-1565</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-a7c1f02f2da4ff2f8620349d0337b7f96b2ad80e8e6313e6516c99f9ef6cfe7d3</citedby><cites>FETCH-LOGICAL-c368t-a7c1f02f2da4ff2f8620349d0337b7f96b2ad80e8e6313e6516c99f9ef6cfe7d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29229485$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Jigar N.</creatorcontrib><creatorcontrib>Kumar, Amit</creatorcontrib><creatorcontrib>Yadav, Partap Singh</creatorcontrib><creatorcontrib>Chadha, Rajiv</creatorcontrib><creatorcontrib>Datta, Vikram</creatorcontrib><creatorcontrib>Roy Choudhury, Subhasis</creatorcontrib><title>The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformations (ARM), using the center of the midline anal dimple (AD) to represent the center of the proposed neoanus, was performed to assess whether or not the AD was located in a significantly abnormal position as correlated with the normal anal position.
The cases comprised 65 consecutive newborn and infants with ARM, divided into 2 age-based groups (Group A: 1st day to 1month; Group B: 1–12months), without sacral or significant perineal abnormalities. Controls included an equal number of age and gender matched patients admitted for other conditions. The characteristics of the AD (‘well developed’ or ‘moderately developed’) as well as those of the midline perineal raphé in males and the perineal groove in females were also recorded.
Combining both age groups, the mean API±SD was 0.41±0.012 in male cases and 0.53±0.07 in male controls (p value 0.003). The corresponding values for female cases and controls were 0.31±0.09 and 0.36±0.07 respectively (p = 0.040). In male newborns, the API in cases was significantly lower than the API in controls (p<0.001). Combining both males and female newborns, the differences between the API in cases and controls was also statistically significant (p<0.001). In older boys as well as in girls from both age groups, apart from cases of persistent cloaca, the API was lower in cases than in controls, especially in boys, although the difference was not statistically significant. On comparing the API in individual male ARM with that in male controls, cases of rectobulbar urethral fistula (RBUF) and rectovesical fistula had a statistically significant lower API (p<0.001). In the 4 cases of persistent cloaca, the mean API (0.40±0.1) was higher than the mean API in female controls and the AD was well developed with a well-delineated, narrow perineal groove. The majority (53/65; 81.53%) of patients had a ‘well developed’ AD. Twelve patients (18.47%) had a ‘moderately developed’ AD including 10 females and 2 males. There were 15 patients with a depressed AD (anal fossette); of these 12 (80%) were females. All boys had a well delineated perineal raphé in contrast to 10 girls (29.4% of total female ARM) who had a poorly delineated midline perineal groove.
During definitive surgery for ARM, if the AD is taken as the site of the proposed neoanus, the neoanal position is likely to be anterior to the normal anal position in both males and females and especially so in males. Overall, girls with ARM appear to be more likely to have a relatively poorly developed and/ or depressed AD and a poorly delineated perineal groove.
Clinical Research.
Level III.</description><subject>Anal Canal - abnormalities</subject><subject>Anal Canal - anatomy & histology</subject><subject>Anal dimple</subject><subject>Anal position index</subject><subject>Anorectal malformation</subject><subject>Anorectal Malformations - diagnosis</subject><subject>Cloaca</subject><subject>Congenital pouch colon</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Perineum - abnormalities</subject><subject>Perineum - anatomy & histology</subject><subject>Prospective Studies</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkUFv1DAQhS0EokvhL1Q5ckmYsbNOcgNVFJAqcSlny2uPqVeJHewsFX-A341Ddrlysubpe_PkeYzdIDQIKN8dm-NMNp_S94YDdg1iA614xna4F1jvQXTP2Q6A81q0sr9ir3I-AhQZ8CW74gPnQ9vvd-z3wyNVc8x-8TFU0VVLmXXQY2X9NI9U-VAFejrEFHLRbZmdDkuunvzyWISYyCyFnvToYpr0uuYMFsjElGj8K26GdXtYuXELuSS_Zi-cHjO9Ob_X7Nvdx4fbz_X9109fbj_c10bIfql1Z9ABd9zq1jnueslBtIMFIbpD5wZ54Nr2QD1JgYLkHqUZBjeQk8ZRZ8U1e7vtnVP8caK8qMlnQ-OoA8VTVjh0EqBrURZUbqhJMedETs3JTzr9Ughq7UAd1aUDtXagEFXpoBhvzhmnw0T2n-1y9AK83wAqP_3pKalsPAVD1q_XVDb6_2X8Ad6-nvI</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Patel, Jigar N.</creator><creator>Kumar, Amit</creator><creator>Yadav, Partap Singh</creator><creator>Chadha, Rajiv</creator><creator>Datta, Vikram</creator><creator>Roy Choudhury, Subhasis</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201808</creationdate><title>The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position</title><author>Patel, Jigar N. ; Kumar, Amit ; Yadav, Partap Singh ; Chadha, Rajiv ; Datta, Vikram ; Roy Choudhury, Subhasis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-a7c1f02f2da4ff2f8620349d0337b7f96b2ad80e8e6313e6516c99f9ef6cfe7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anal Canal - abnormalities</topic><topic>Anal Canal - anatomy & histology</topic><topic>Anal dimple</topic><topic>Anal position index</topic><topic>Anorectal malformation</topic><topic>Anorectal Malformations - diagnosis</topic><topic>Cloaca</topic><topic>Congenital pouch colon</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Perineum - abnormalities</topic><topic>Perineum - anatomy & histology</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Jigar N.</creatorcontrib><creatorcontrib>Kumar, Amit</creatorcontrib><creatorcontrib>Yadav, Partap Singh</creatorcontrib><creatorcontrib>Chadha, Rajiv</creatorcontrib><creatorcontrib>Datta, Vikram</creatorcontrib><creatorcontrib>Roy Choudhury, Subhasis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Jigar N.</au><au>Kumar, Amit</au><au>Yadav, Partap Singh</au><au>Chadha, Rajiv</au><au>Datta, Vikram</au><au>Roy Choudhury, Subhasis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2018-08</date><risdate>2018</risdate><volume>53</volume><issue>8</issue><spage>1560</spage><epage>1565</epage><pages>1560-1565</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformations (ARM), using the center of the midline anal dimple (AD) to represent the center of the proposed neoanus, was performed to assess whether or not the AD was located in a significantly abnormal position as correlated with the normal anal position.
The cases comprised 65 consecutive newborn and infants with ARM, divided into 2 age-based groups (Group A: 1st day to 1month; Group B: 1–12months), without sacral or significant perineal abnormalities. Controls included an equal number of age and gender matched patients admitted for other conditions. The characteristics of the AD (‘well developed’ or ‘moderately developed’) as well as those of the midline perineal raphé in males and the perineal groove in females were also recorded.
Combining both age groups, the mean API±SD was 0.41±0.012 in male cases and 0.53±0.07 in male controls (p value 0.003). The corresponding values for female cases and controls were 0.31±0.09 and 0.36±0.07 respectively (p = 0.040). In male newborns, the API in cases was significantly lower than the API in controls (p<0.001). Combining both males and female newborns, the differences between the API in cases and controls was also statistically significant (p<0.001). In older boys as well as in girls from both age groups, apart from cases of persistent cloaca, the API was lower in cases than in controls, especially in boys, although the difference was not statistically significant. On comparing the API in individual male ARM with that in male controls, cases of rectobulbar urethral fistula (RBUF) and rectovesical fistula had a statistically significant lower API (p<0.001). In the 4 cases of persistent cloaca, the mean API (0.40±0.1) was higher than the mean API in female controls and the AD was well developed with a well-delineated, narrow perineal groove. The majority (53/65; 81.53%) of patients had a ‘well developed’ AD. Twelve patients (18.47%) had a ‘moderately developed’ AD including 10 females and 2 males. There were 15 patients with a depressed AD (anal fossette); of these 12 (80%) were females. All boys had a well delineated perineal raphé in contrast to 10 girls (29.4% of total female ARM) who had a poorly delineated midline perineal groove.
During definitive surgery for ARM, if the AD is taken as the site of the proposed neoanus, the neoanal position is likely to be anterior to the normal anal position in both males and females and especially so in males. Overall, girls with ARM appear to be more likely to have a relatively poorly developed and/ or depressed AD and a poorly delineated perineal groove.
Clinical Research.
Level III.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29229485</pmid><doi>10.1016/j.jpedsurg.2017.11.043</doi><tpages>6</tpages></addata></record> |
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| ispartof | Journal of pediatric surgery, 2018-08, Vol.53 (8), p.1560-1565 |
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| language | eng |
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| source | ScienceDirect Journals |
| subjects | Anal Canal - abnormalities Anal Canal - anatomy & histology Anal dimple Anal position index Anorectal malformation Anorectal Malformations - diagnosis Cloaca Congenital pouch colon Female Humans Infant Infant, Newborn Male Perineum - abnormalities Perineum - anatomy & histology Prospective Studies |
| title | The position of the anal dimple in newborns and infants with anorectal malformations and its correlation with the normal anal position |
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