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Anal endosonography for identifying external sphincter defects confirmed histologically
A H Sultan1, M A Kamm, I C Talbot
1Department of Radiology, St Mark's Hospital, London, UK.
The British Journal of Surgery
|March 1, 1994
Summary
Anal endosonography accurately detects external anal sphincter defects, outperforming traditional methods like manometry and EMG. This imaging technique is crucial for diagnosing fecal incontinence and guiding precise sphincter repair.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- External anal sphincter defects are traditionally diagnosed via palpation, manometry, and EMG.
- Anal endosonography offers clear visualization of internal and external anal sphincter muscles.
Purpose of the Study:
- To validate ultrasonographic interpretation of external sphincter defects using histology.
- To prospectively compare the diagnostic accuracy of clinical examination, manometry, EMG, and anal endosonography for sphincter defects.
Main Methods:
- Twelve patients with fecal incontinence underwent clinical assessment, anal manometry, EMG mapping, and anal endosonography before surgery.
- Histology served as the gold standard for defect verification.
- Surgeons and pathologists were blinded to imaging and physiological test results.
Main Results:
- Histology confirmed external sphincter defects in nine of 12 patients.
- Anal endosonography correctly identified all nine defects and three normal sphincters (100% accuracy).
- Clinical examination accuracy was 50%, while EMG and manometry were 75% accurate. Endosonography also identified internal sphincter defects in eight patients.
Conclusions:
- Anal endosonography is a highly accurate method for diagnosing external anal sphincter defects, surpassing conventional diagnostic techniques.
- Precise assessment of anal sphincter integrity is essential for effective fecal incontinence management.
- Anal endosonography provides valuable information on both external and internal anal sphincters, aiding in surgical planning.