2025 – PAGE 242 – GASTROENTEROLOGY
IMPERFORATE ANUS (AKA ANAL ATRESIA)
Imperforate anus (AKA anal atresia) presents with abdominal distension within the first 48 hours of life and the failure to pass meconium. The anus might be more anteriorly located. Some patients may have a fistula leading to the vaginal or urinary tract.
IMAGE: www.pbrlinks.com/ANALATRESIA1
- (TRIPLE TAKE) VACTER-L (AKA VACTERL or VATER) ASSOCIATION: VACTER-L (AKA VACTERL or VATER) syndrome is an acronym. VACTERL stands for Vertebral anomalies, Anal atresia/imperforate anus, Cardiac defects (especially VSD), Tracheoesophageal fistula, Radial hypoplasia, Renal anomalies, and Limb abnormalities. These children have a normal IQ.
- PEARL: The patient may present with a single umbilical artery.
- MNEMONIC: Imagine Darth VACTER cutting off his own son’s ARM (radial hypoplasiaand limb abnormalities) and then using the ARM as a light saber to create ANAL ATRESIA and a TE Fistula.
- IMAGE: www.pbrlinks.com/VACTERL1
- IMAGE: www.pbrlinks.com/VACTERL2
PERSISTENT CLOACA
Persistent cloaca refers to the presence of a single channel consisting of the rectum, vagina, and urinary tract (which did not separate in utero). It requires immediate surgery to prevent severe urinary tract complications. This should be suspected clinically in any female child with an imperforate anus.
RECTAL PROLAPSE
Rectal prolapses are usually due to CONSTIPATION or diarrhea (or a polyp), but screen for cystic fibrosis. Also caused by “TRICK YOur A$$ out” or “WHIP your A$$ out!” = Trichuris = Whipworm. Also by Shigella!
TYPHLITIS (AKA NEUTROPENIC ENTEROCOLITIS)
If you are presented with a clinical description in an older child with leukopenia or neutropenia that sounds like NEC, choose typhlitis as the answer.
(DOUBLE TAKE) NECROTIZING ENTEROCOLITIS (NEC)
Necrotizing enterocolitis (NEC) is a serious complication in a newborn that happens when the mucosa of the colon gets inflamed. It is most common in premature infants < 1,500 grams. The cause is unknown but thought to be related to hypoxia to the intestines resulting in secondary bacterial infection and possible intestinal perforation. It commonly presents with a sudden change in feeding intolerance. Additional signs and symptoms may include thrombocytopenia, anemia, bloody stool, apnea, bilious residuals, distended abdomen, tender abdomen or poor feeding. Diagnosis is with the presence of clinical features and a KUB showing air in the intestinal walls (PNEUMATOSIS INTESTINALIS). Treatment is with NPO status, NG tube to suction and broad-spectrum antibiotics. Sometimes surgical removal of a portion of the intestine is required.
PEARL: If you are presented with a similar clinical description in an older child with leukopenia or neutropenia, choose typhlitis (AKA neutropenic enterocolitis) as the answer instead.