Correlation between development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations

Abstract

Objective To investigate the relationship between the development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations (ARMs) in order to improve the understanding of rectal ganglion development abnormalities in ARMs patients. Methods A retrospective trial was conducted on the male patients with complex ARMs admitted to our hospital from 2015 to 2021. The terminal rectal specimens were taken from them during anoplasty. According to the findings on development of terminal rectal ganglion after HE staining, the patients were classified into G1 group (ganglion cells observed) and G2 group (no ganglion cells observed). Imaging techniques were used to evaluate whether there were abnormalities in the spinal cord and sacrum, and their correlation with the terminal rectal ganglion development was analyzed. Results A total of 139 patients were enrolled, and their median age at anoplasty was 5.77(4.57, 6.97) months. There were no significant differences between the G1 (n=80, 57.6%) and G2 (n=59, 42.4%) groups in ARMs pathological type (P=0.706) and age at surgery (P=0.140). Radiological findings showed there were 48 cases (34.5%) of spinal cord anomalies (SCA), 25 cases (18.0%) of sacral abnormalities and 18 cases (12.9%) of coccyx abnormalities. No significant differences were observed in the incidences of SCA and sacral abnormalities between the G1 and G2 groups (P<0.05). Moreover, the differences of fatty filum terminale and syrinx were statistically significant (P<0.05). In addition, the ratio of sacrum to coccyx between the G1 and G2 groups were 0.72±0.10 vs 0.67±0.12 (P<0.05) of the anteroposterior position and 0.77±0.09 vs 0.72±0.09 (P<0.05) of the lateral position. Multivariate logistic regression analysis showed that sacral abnormalities, fatty filum terminale and syrinx were independent predictors of rectal terminal ganglion absence in male patients with complex ARMs. Conclusion The development of terminal rectal ganglia in male patients with ARMs is closely associated with the abnormalities of spinal cord and sacrum. Sacral abnormalities, fatty filum terminale and syrinx are independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.

Keywords

• anorectal malformations
• terminal rectal ganglion cells
• spinal cord anomalies
• sacral anomalies