Ultrasound imaging of the anorectal malformation during the neonatal period: a comprehensive review

Takahiro Hosokawa, Yoshitake Yamada, Mayumi Hsokawa, Shunsuke Kikuchi, Kenji Ohira, Yutaka Tanami, Yumiko Sato, Eiji Oguma

Research output: Contribution to journalReview articlepeer-review

12 Citations (Scopus)


Anorectal malformation (ARM) is classified as low, intermediate, or high; accurate diagnosis of the type during the early neonatal period is important to determine the appropriate initial surgical approach. This review assesses the role of ultrasound examination in the classification of ARM during the neonatal period, with a focus on landmarks on the sonogram, the approach used for sonography, and the optimal examination timing. The following three factors on the sonogram are used for the classification: location of the fistula, the distance between the distal rectal pouch and the anal dimple (perineum) (P–P distance), and the relationship between the puborectalis muscle and the distal rectal pouch. Three approaches can be used to evaluate ARM by ultrasonography, namely, suprapubic, perineal, and infracoccygeal approaches. Each approach has its own advantages and disadvantages. Optimal timing of the ultrasound examination is also important with respect to each factor to classify ARM. We have described the pitfalls of ultrasound in diagnosis of cases, namely ARM with Down syndrome (which tends to be without fistula), ARM with low birth weight, ARM with unusual location of fistula, ARM with opened fistula (where the P–P distance is unreliable), and cloacal malformation (variation of the high-type ARM).

Original languageEnglish
Pages (from-to)581-591
Number of pages11
JournalJapanese Journal of Radiology
Issue number10
Publication statusPublished - 2018 Oct 1


  • Anorectal malformation
  • Imperforate anus
  • Sonography
  • Ultrasonography
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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