Comparison of Invertography and Perineal Ultrasonography in the Initial Evaluation of Anorectal Malformations

This study was designed to compare the efficacy of perineal ultrasonography and invertography in the diagnostic assessment of Anorectal malformations (ARM) in children. 96 Children presenting with Anorectal malformations in the Pediatric surgery unit of the Department of Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh during a period from Jan 2007 to Sep 2009 were included in the study. Invertography and perineal ultrasonography were done accordingly. All clinical, radiological and operative data collected were analyzed in a tabulated form and the results were analyzed. Using operative findings as the gold standard, the accuracy of the perineal ultrasonography and invertography was compared. Paired student t-test was used for calculating differences between means. On the evaluation of 96 patients, Invertography was found less reliable (29.2%) in calculating bowel skin distance as compare to perineal ultrasonography (95.8%). In all the cases of invertography, the bowel-skin distance (P-P) was greater than the real one. The bowel skin distance found intraoperatively and on invertography was statistically different. In 14 patients invertogram diagnosed high type malformation which was later found as low type on perineal ultrasonography. These patients were successfully treated by definitive single stage repair, and the validity of perineal ultrasonography was confirmed. Perineal ultrasonography was found very useful as compare to conventional invertography for early assessment, and may be relied upon when making decisions for or against colostomy.