Panel Discussion and Case Presentation Part I: Pediatric Bowel Management 2013

The sacral ratio correlates with prognosis for bowel control in anorectal malformation patients

Normal sacral ratio is 0.7 or more, indicating good prognosis for bowel control

Sacral ratio of 0.4 or less means the patient will be fecally incontinent regardless of malformation type

No patient with sacral ratio less than 0.4 has ever been observed to be fecally continent

Patients with sacral ratio 0.4 or less will need enemas for life

The only indication for permanent colostomy is incapacity to form solid stool

Bad prognosis for bowel control does not mean the patient is a candidate for permanent colostomy

Patients subjected to bowel management report better quality of life than having a colostomy

With incapacity to form solid stool there is no bowel management option

Patients with Down syndrome and anorectal malformation have 80% chance of bowel control

Only 15% of patients with rectal bladder neck fistula have bowel control

Rectal perineal fistula is the malformation with the best prognosis for bowel control

Good prognosis depends upon having a good operation, good sacrum, and no tethered cord

It is important to rule out a presacral mass before discussing prognosis for bowel control

Hemisacrum indicates the patient has a presacral mass

Hemisacrum and presacral mass change the prognosis for bowel control completely, even in rectal perineal fistula

Many patients born with perineal fistula have had terrible problems because presacral mass was not detected and not treated when surgeons did not take an x-ray film of the sacrum

The majority of patients with cloacal exstrophy will be fecally incontinent

Cloacal exstrophy patients have high rates of tethered cord, myelomeningocele, and abnormal sacrum

Not all patients with cloacal exstrophy are fecally incontinent; a few patients are fecally continent