To Evaluate and Explain the Consequences of Abnormal Anal Sphincter Morphology Using the 3-Dimensional Endosonography

Ashraf Talaat Youssef

doi:10.1155/2014/131032

Abstract

The Objective of the Study. To evaluate and explain the consequences of different morphological abnormalities of anal sphincters including the sphincter damage and its extent using the 3-dimensional endosonography. Material and Methods. 56 patients suffering from fecal incontinence all were subjected to analysis of patient symptoms, scoring the severity of symptoms, digital examination, electromyography, and 3D endoanal ultrasonography. Results. 5 patients showed intact anal sphincters and puborectalis muscle. 4 patients found with thick IAS > 4 mm, 4 patients with thin IAS < 2 mm. 3 patients with thin EAS, 12 patients with IAS defects, 15 patients with EAS defects, 8 patients with combined IAS and EAS defects, 2 patients with puborectalis muscle defects and 3 patients with high levels transsphincteric perianal fistulas. Conclusion. No significant relationship was observed between sphincter damage except for combined internal and external sphincter injury and the severity score of FI symptoms. Puborectalis muscle injury and abnormal sphincter thickness are unlikely causes of severe FI.

Highlights

Anal continence recommends the integrity of all parts of anorectal region
When the surroundings are suitable defecation proceeding with rising of intra-abdominal pressure, relaxation of the puborectalis muscle with subsequent increase of the anorectal angle and relaxation of external anal sphincter to get rid of fecal matter, but when the surroundings are unsuitable voluntary contraction of external anal sphincter and puborectalis muscle leads to inhibition of rectoanal inhibitory reflex, relaxation of rectal wall muscles and subsequent backward colonic peristalsis force the fecal matter to return back to the colon [1]
56 patients with fecal incontinence (FI) were examined (Table 1), 5 patients showed intact anal sphincters and puborectalis muscle (Figures 1, 2, and 3), and 4 patients were found with thick internal anal sphincter (IAS) > 4 mm (Figure 4) and 4 patients with thin IAS < 2 mm

Summary

Introduction

When the rectum distends with fecal matter stretch receptors in its walls, send rectoanal inhibitory reflex which relax the internal anal sphincter (IAS) and contract the external anal sphincter (EAS). When the surroundings are suitable defecation proceeding with rising of intra-abdominal pressure, relaxation of the puborectalis muscle with subsequent increase of the anorectal angle and relaxation of external anal sphincter to get rid of fecal matter, but when the surroundings are unsuitable voluntary contraction of external anal sphincter and puborectalis muscle leads to inhibition of rectoanal inhibitory reflex, relaxation of rectal wall muscles and subsequent backward colonic peristalsis force the fecal matter to return back to the colon [1]. Three-dimensional (3D) endoanal ultrasound helps to assess accurately the extent of anal sphincter damage in 3 perpendicular planes (axial, coronal, and sagittal). The coronal plane is the blind plane for 2D ultrasound [4,5,6]

Methods

Results

Conclusion