Alon U, Berant M, Bar-Maor J A
Int J Pediatr Nephrol. 1986 Apr-Jun;7(2):121-4.
An infant with high anal atresia and transverse colostomy, in whom initial radiologic evaluation of the urinary tract had been normal, developed hyperchloremic metabolic acidosis at 24 days of age. Gastroenteritis and renal tubular acidosis as possible causes for this metabolic disturbance were excluded, which prompted a repeat investigation of the possibility of a communication between the urinary tract and the rectum. A recto-urethral fistula was demonstrated by urethrography. Analysis of the fluid obtained from the left colon as compared to urine in the bladder and voided urine demonstrated that electrolyte exchange was taking place in the colon, resulting in hyperchloremic hypokalemic acidosis. Treatment with oral sodium bicarbonate and daily lavage of the left colon resulted in normalization of the acid-base status and catch-up growth of the baby. Hyperchloremic acidosis associated with anal atresia and recto-urinary communication appears to be uncommon. However, early diagnosis and treatment of the metabolic derangement are of importance as it may determine the infant's overall prognosis.
一名患有高位肛门闭锁并接受横结肠造口术的婴儿，其泌尿系统的初始放射学评估结果正常，但在24日龄时出现了高氯性代谢性酸中毒。排除了可能导致这种代谢紊乱的胃肠炎和肾小管酸中毒，这促使对尿路与直肠之间存在连通的可能性进行再次调查。尿道造影显示存在直肠尿道瘘。对从左结肠获取的液体与膀胱尿液及排尿尿液进行分析表明，结肠中发生了电解质交换，导致高氯性低钾性酸中毒。口服碳酸氢钠及每日对左结肠进行灌洗的治疗使酸碱状态恢复正常，婴儿实现了追赶生长。与肛门闭锁及直肠尿路连通相关的高氯性酸中毒似乎并不常见。然而，对代谢紊乱进行早期诊断和治疗很重要，因为这可能决定婴儿的总体预后。
