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Normal anorectal musculatures and changes in anorectal malformation

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A Letter to the Editor to this article was published on 15 June 2020

Abstract

Purpose

We investigated the anorectal musclulature in normal children and anorectal malformations (ARM) to evaluate its role in bowel control mechanism.

Methods

Pelves of 50 neonates died of ARM-unrelated diseases and 16 patients with anorectal malformations (8 high, 5 intermediate, and 3 low ARMs) were dissected and analyzed.

Results

Normal anorectal musculature was divided into three muscular tubes: the internal sphincter tube (IAST), longitudinal muscle tube (LMT) and transverse muscle tube (TMT). The LMT came from the outer longitudinal smooth muscle fiber of the rectum and the striated muscle fiber of the levator ani, and the TMT composed of the puborectalis and the external anal sphincter. However, in ARM, the IAST was absent and the LMT, the center of the sphincter muscle complex, was only from the levator ani and could be divided into the pelvic portion and the perineal portion. The former, from the upper rim of the puborectalis to the bulbar urethral, became narrowed and dislocated anteriorly near to the posterior urethra in high ARM and rectal pouch in intermediate ARM. The latter, below the bulbar urethra to the anal dimple, was fused to a column both in high and intermediate ARM. The columnar perineal LMT run downwards and then split, penetrated the superficial part of EAS and terminated at the deep aspect of the skin, to form the anal dimple, which represents the center of the perineal LMT from the perineal aspect. The length of the LMT was longer in high and intermediate ARM than the normal neonate. The columnar perineal LMT and narrowed pelvic LMT could be possibly identified by laparoscopic and perineal approaches retrospectively and widened to allow the passage of the rectum through.

Conclusions

The anorectal musculature in ARM is composed of agenesic LMT and TMT and the narrowed LMT gives anatomical evidence of the center, where the neorectum should pull through.

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Acknowledgements

We thank Professor Paul KH Tam for his help and support in revising the article.

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Authors and Affiliations

  1. Department of Pediatric Surgery, The Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People’s Republic of China

    Long Li, Xianghai Ren, Hui Xiao, Hang Xu, Anxiao Ming, Xueqi Wang, Mei Diao & Wei Cheng

  2. Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, People’s Republic of China

    Changlin Wang & Zheng Li

  3. Departments of Pediatrics and Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia

    Wei Cheng

  4. New Century Healthcare, Sha Tin, Hong Kong

    Wei Cheng

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  1. Long Li
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  2. Xianghai Ren
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Correspondence to Long Li or Wei Cheng.

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Li, L., Ren, X., Xiao, H. et al. Normal anorectal musculatures and changes in anorectal malformation. Pediatr Surg Int 36, 103–111 (2020). https://doi.org/10.1007/s00383-019-04583-1

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