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6
Photographic Album of Anorectal Malformations
and the Sphincter Muscles
F. Douglas Stephens
The specimens presented in the accompanying compact 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 sphincter muscles of the anorectum. Kascot Media Incorporated (Chicago, Illinois, USA) rephotographed the
Cibachromes and diagrams and arranged the layout
in the original atlas.
The prints have been traced and colored. The schematic 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 cartilage. 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-quarTable 6.1 Index of anomalies
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 illustration (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 channel (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
Index of Anomalies
Malformation
Figures
Anomaly: female
Normal male pelvis
6.29–6.30
• Normal female
1F, 2F
Rectoprostatic urethral fistula
6.31–6.33
• High anomaly
3F
Rectobulbar urethral fistula (paremedian)
6.34–6.35
• Intermediate anomalies
4–6F
Rectobulbar fistula
6.36–6.38
• Low anomalies
7–10F
Rectobulbar fistula (A+B)
6.39–6.40
Anocutaneous fistula
6.41–6.43
1M
Anocutaneous fistula
6.44–6.45
• High anomaly
2M
Anocutaneous fistula (bucket handle)
6.46–6.48
• Intermediate anomalies
3–5M
Anocutaneous fistula
6.49–6.51
• Low anomalies
6–10M
Imperforate anal membrane
6.52–6.55
Anomaly: male
• Normal male
88
F. Douglas Stephens
Fig. 6.1