4575 Disruption of the external anal sphincter by endorectal ultrasonography correlates with maximal squeeze tone in fecal incontinence.

Abstract

Background: Prior studies have correlated sphincter anatomy as seen by ERUS with manometry in healthy patients. There is little data regarding the correlation between sphincter defects as seen by ERUS to manometry for the evaluation of fecal incontinence. Aims: To determine whether defects seen either in the internal anal sphincter (IAS) or EAS by ERUS correlated with either the basal or maximal squeeze sphincter pressures in patients with fecal incontinence. Methods: Thirty patients (20F, 10M, mean age 58.7 ± 2.8) underwent anorectal manometry using a low compliance perfusion anorectal manometry catheter (Medtronics®, Minneapolis,MN) followed by ERUS using either the Olympus GFUM20 or GFUM 130 (Olympus America, Melville, NY) for the management of fecal incontinence between 1/97 and 10/99. Basal (nl >55 mm Hg) and maximal squeeze pressures (nl >100 mm Hg) were recorded. The endosonographers were blinded to the manometric findings. Statistical analysis using unpaired t-test was performed to compare the maximal squeeze tone in intact vs. disrupted EAS by ERUS. Results: 24 patients successfully completed both the manometry and the ERUS. Defects in the EAS were seen in 7 patients. There was no difference seen in the basal pressures in patients with intact vs. those with disrupted EAS (32 ± 3.8 vs. 29.8 ± 4., p=0.7106). Patients with an intact EAS were found to have a higher maximal squeeze tone than those with a disrupted EAS (67.5 ± 9.4 vs. 29.0 ± 7.9, p=0.02).