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[Occult anal sphincter tear--up-to-date knowledge]
V Kalis1, Z Chudácek, J Stepán
1Gynekologicko-porodnická klinika LF UK a FN Plzen.
Ceska Gynekologie
|October 31, 2007
Summary
Occult anal sphincter tears are injuries not detectable by physical exam but visible with endoanal ultrasonography, occurring in about 2% of vaginal deliveries. Improved diagnostics rely on careful perineal examination and anatomical knowledge.
Area of Science:
- Obstetrics and Gynecology
- Diagnostic Imaging
- Surgical Anatomy
Background:
- Anal sphincter injuries can be subtle and missed during routine postpartum examinations.
- Understanding the anatomy of the anal sphincter is crucial for accurate diagnosis.
- Occult injuries may lead to long-term complications if undiagnosed.
Purpose of the Study:
- To summarize current knowledge on sonographically and clinically detectable anal sphincter injuries.
- To define occult anal sphincter tears and their diagnostic methods.
- To review the incidence and diagnostic approaches for anal sphincter defects.
Main Methods:
- Systematic review of international literature.
- Analysis of diagnostic criteria for anal sphincter injuries.
- Evaluation of endoanal ultrasonography as a diagnostic tool.
Main Results:
- Occult anal sphincter tears are clinically undetectable injuries identified via endoanal ultrasonography.
- Sonographically detected anal sphincter defects range from 19% to 67%.
- Isolated internal anal sphincter defects represent true occult injuries, found in approximately 2% of vaginal deliveries.
Conclusions:
- Diligent digital examination and anatomical education are key to improving diagnosis of anal sphincter injuries.
- Endoanal ultrasound can aid in the diagnosis of occult anal sphincter tears.
- Many clinically detectable injuries are likely missed, highlighting the need for enhanced diagnostic strategies.
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