87
The specimens presented in the accompanying com- pact 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 sphinc- ter muscles of the anorectum. Kascot Media Incor- porated (Chicago, Illinois, USA) rephotographed the Cibachromes and diagrams and arranged the layout in the original atlas.
The prints have been traced and colored. The sche- matic 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 carti- lage. 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-
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 illustra- tion (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 chan-
nel (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
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
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
F. Douglas Stephens
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
F. Douglas Stephens
88
Fig. 6.1
89
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.2 Normal female pelvis (1F.1)
F. Douglas Stephens
90
Fig. 6.3 Normal female pelvis (1F.2)
91
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.4 Normal female pelvis (2F.1)
F. Douglas Stephens
92
Fig. 6.5 Normal female pelvis (2F.2)
93
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.6 Rectovesical fistula (phallic urethra), female (3F.1)
F. Douglas Stephens
94
Fig. 6.7 Rectovesical fistula (phallic urethra) (3F.2)
95
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.8 Rectovesical fistula (phallic urethra) (3F.3)
F. Douglas Stephens
96
Fig. 6.9 Rectovestibular or low rectocloacal fistula (absent vagina) (4F.1)
97
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.10 Rectovestibular or low cloacal fistula (absent vagina) (4F.2)
F. Douglas Stephens
98
Fig. 6.11 Rectovestibular or low rectocloacal fistula (absent vagina) (4F.3)
99
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.12 Cloacal anomaly (absent vagina, same as Fig. 6.11) (4F.4)
F. Douglas Stephens
100
Fig. 6.13 Cloaca with short conduit atrophic microcaliber vagina (5F.1)
101
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.14 Cloaca with short conduit atrophic microcaliber vagina (5F.2)
F. Douglas Stephens
102
Fig. 6.15 Cloaca with short conduit atrophic microcaliber vagina (5F.3)
103
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.16 Anorectal atresia, female (also multiple intestinal atresias) (6F.1)
F. Douglas Stephens
104
Fig. 6.17 Anorectal atresia, female (6F.2)
105
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.18 Anorectal atresia, female (also multiple intestinal atresias) (6F.3)
F. Douglas Stephens
106
Fig. 6.19 Anovestibular fistula, female (7F.1)
107
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.20 Anovestibular fistula, female (7F.2)
F. Douglas Stephens
108
Fig. 6.21 Anterior anus, transverse section at anus slightly oblique (8F.1)
109
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.22 Anterior anus, transverse section at pectinate line (8F.2)
F. Douglas Stephens
110
Fig. 6.23 Anocutaneous fistula, female (septate vagina and agenesis of S2–5 and coccyx) (9F.1)
111
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.24 Anocutaneous fistula, female (9F.2)
F. Douglas Stephens
112
Fig. 6.25 Anocutaneous fistula, female (9F.3)
113
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.26 Perineal groove, female (10F.1)
F. Douglas Stephens
114
Fig. 6.27 Perineal groove, female (10F.2)
115
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.28 Perineal groove, female (10F.3)
F. Douglas Stephens
116
Fig. 6.29 Normal male pelvis (1M.1)
117
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.30 Normal male pelvis (1M.2)
F. Douglas Stephens
118
Fig. 6.31 Rectoprostatic urethral fistula, male (2M.1)
119
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.32 Rectoprostatic urinary fistula, male (2M.2)
F. Douglas Stephens
120
Fig. 6.33 Rectoprostatic urinary fistula, male (2M.3)
121
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.34 Rectobulbar fistula, paramedian section (3M.1)
F. Douglas Stephens
122
Fig. 6.35 Rectobulbar fistula (3M.2)
123
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.36 Rectobulbar fistula, male (4M.1)
F. Douglas Stephens
124
Fig. 6.37 Rectobulbar fistula, male (4M.2)
125
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.38 Rectobulbar fistula, male (4M.3)
F. Douglas Stephens
126
Fig. 6.39 Rectobulbar fistula (approximately section A) (5M.1)
127
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.40 Rectobulbar fistula (approximately section B) (5M.2)
F. Douglas Stephens
128
Fig. 6.41 Anocutaneous fistula, male (6M.1)
129
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.42 Anocutaneous fistula, male (6M.2)
F. Douglas Stephens
130
Fig. 6.43 Anocutaneous fistula, male (6M.3)
131
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.44 Anocutaneous fistula, male (7M.1)
F. Douglas Stephens
132
Fig. 6.45 Anocutaneous fistula, male (7M.2)
133
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.46 Bucket handle anocutaneous fistula, male (8M.1)
F. Douglas Stephens
134
Fig. 6.47 Bucket handle male anocutaneous fistula (8M.2)
135
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.48 Bucket handle anocutaneous fistula, male (8M.3)
F. Douglas Stephens
136
Fig. 6.49 Anocutaneous fistula, male (9M.1)
137
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.50 Anocutaneous fistula, male (9M.2)
F. Douglas Stephens
138
Fig. 6.51 Anocutaneous fistula, male (9M.3)
139
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.52 Imperforate anal membrane, male (10M.1)
F. Douglas Stephens
140
Fig. 6.53 Imperforate anal membrane, male (10M.2)
141
6 Photographic Album of Anorectal Malformations and the Sphincter Muscles
Fig. 6.54 Imperforate anal membrane, male (10M.3)
F. Douglas Stephens
142
Fig. 6.55 Imperforate anal membrane, male (10M.4)
