[Anorectal echo-endoscopy: applications in pediatrics]

PEDIATRIC INDICATIONS: Anorectal echoendoscopy is widely used in adults for the pretreatment work-up of rectal cancer and for the exploration of fecal incontinence. It can also be useful in the pediatric setting as recently described with rotative or linear heads. The exploration can be performed after an evacuating enema or if needed after giving a neuroleptanalgesic. The anorecal walls and neighboring areas-bladder, genital organs, perirectal spaces, vessels-can be explored. The ultrasonographic aspect of the walls is similar to that described in adults although less thick, particularly at the level of the anus sphincters. Signs of defects, abscesses and fistulizations are the same as in adults. BOWEL DISORDERS AND INCONTINENCE: Echoendoscopy can characterize rare subepithelial tumors of the rectum and vascular anomalies, but its main interest is for the exploration of bowel disorders and incontinence, particularly after surgical treatment for anorectal malformations. The quality of the muscular tissue and the quality of the surgical repair can be assessed before deciding on the need for a second operation. In this context, anorectal echoendoscopy can also disclose Hirschsprung's disease and other forms of idiopathic megarectum, including certain types with major thickening of the internal sphincter. It can also detect defects induced by prior disimpaction maneuvers. A NONINVASIVE EXAM: Anorectal echoendoscopy is a promising exploration technique in pediatric gastroenterology. Descriptions of the sphincters and anorectal anatomy are very precise and descriptions of functional disorders, whether primary or secondary to surgery, can be quite helpful for guiding subsequent management.