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[Post-surgical or traumatic anal incontinences. Prospective study in 40 patients explorated by endorectal
A Aubert1, H Mosnier, G Amarenco
1Service de Chirurgie Digestive, CMC Foch, Suresnes.
Objectives:
Anal endosonography is used to assess anal canal structure and external anal sphincter. The purpose of this study was to compare findings at anal endosonography with electromyographic tests in patients with faecal incontinence.
Methods:
Fourty patients (31 women; median age: 47 years) were referred for exploration of the anal sphincter: 15 patients had previous anal surgery, 16 patients had obstetrical trauma, 3 patients had accidental trauma, 6 women had obstetrical trauma and previous anal surgery.
Results:
Anal endosonography demonstrated an external sphincter defect in 19 patients (partial n = 4, complete n = 15); 18 of these patients had an electromyographic study: an external sphincter defect was demonstrated by mapping in 15 cases; 3 partial defects were not found. Eight patients had associated pudendal nerve terminal motor latency delayed due to neuropathic impairment of pudendal nerve. Surgery was performed in 12 patients; external sphincter lesion was confirmed in all cases.
Conclusions:
Anal endosonography and electromyography mapping easily recognize external sphincter disruption with high concordance. Partial defects are better diagnosed by anal endosonography. A study of pudendal nerve terminal motor latency is useful in the exploration of faecal incontinence because pudendal neuropathy occurs frequently in association with a sphincter defect.