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Clinical Gastroenterology and... Oct 2015The anal sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at...
BACKGROUND & AIMS
The anal sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. By using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures.
METHODS
We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomic parameters were evaluated with univariate and multivariate analyses.
RESULTS
Fecal incontinence (55 patients; 46%) and constipation (36 patients; 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P ≤ .001), and internal sphincter (P < .01), but not puborectalis (P = .09) or external sphincter (P = .06), injury. Internal (P < .01) and external sphincter injury (P = .02) and a patulous canal (P < .001), but not puborectalis injury, predicted anal resting pressure. A patulous anal canal was the only significant predictor (P < .01) of the anal squeeze pressure increment.
CONCLUSIONS
Patients with anorectal disorders commonly have a patulous anal canal, which is associated with more severe anal injury and independently predicted anal resting pressure and squeeze pressure increment. It therefore is important to identify a patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation.
Topics: Adult; Aged; Anal Canal; Anus Diseases; Female; Humans; Hydrostatic Pressure; Magnetic Resonance Imaging; Male; Manometry; Middle Aged; Perineum; Retrospective Studies
PubMed: 25869638
DOI: 10.1016/j.cgh.2015.03.033 -
Dermatology Online Journal Dec 2014Infantile perianal protrusion is characterized by a skin fold located in the perianal area. It is a relatively recent reported condition and affects both infants and... (Observational Study)
Observational Study
Infantile perianal protrusion is characterized by a skin fold located in the perianal area. It is a relatively recent reported condition and affects both infants and prepubertal children with a clear female predominance. Three types are recognized: constitutional/congenital, acquired, and associated with lichen sclerosus et atrophicus. We report eleven new cases, three of whom have the defect in locations that have been reported only once before. We would like to increase the awareness of this condition to avoid erroneous diagnostic and therapeutic procedures.
Topics: Age of Onset; Anal Canal; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies
PubMed: 25780964
DOI: No ID Found -
World Journal of Gastroenterology Feb 2009Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for...
Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis; these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.
Topics: Adenocarcinoma; Anal Canal; Anastomosis, Surgical; Colitis, Ulcerative; Colonic Pouches; Humans; Inflammation; Postoperative Complications; Proctocolectomy, Restorative; Rectal Neoplasms; Sepsis; Sutures; Treatment Outcome
PubMed: 19230038
DOI: 10.3748/wjg.15.769 -
International Urogynecology Journal Apr 2015Women may experience anal sphincter anatomy changes after vaginal birth (VB) or Cesarean delivery (CD). Therefore, accurate and acceptable imaging options to evaluate...
INTRODUCTION AND HYPOTHESIS
Women may experience anal sphincter anatomy changes after vaginal birth (VB) or Cesarean delivery (CD). Therefore, accurate and acceptable imaging options to evaluate the anal sphincter complex (ASC) are needed. ASC measurements may differ between translabial (TLUS) and endoanal (EAUS) ultrasound imaging and between 2D and 3D US. The objective of this analysis was to describe measurement variation between these modalities.
METHODS
Primiparous women underwent 2D and 3D TLUS imaging of the ASC 6 months after VB or CD. A subset of women also underwent EAUS measurements. Measurements included internal anal sphincter (IAS) thickness at proximal, mid, and distal levels and the external anal sphincter (EAS) at 3, 6, 9, and 12 o'clock positions, as well as bilateral thickness of the pubovisceralis muscle (PVM).
RESULTS
There were 433 women presenting for US: 423 had TLUS and 64 had both TLUS and EAUS of the ASC. All IAS measurements were significantly thicker on TLUS than EAUS (all p < 0.01), while EAS measurements were significantly thicker on EAUS (p < 0.01). PVM measurements with 3D or 2D imaging were similar (p > 0.20). On both TLUS and EAUS, there were multiple sites where significant asymmetry existed in left versus right measurements.
CONCLUSIONS
US modality used to image the ASC introduces small but significant changes in measurements, and the direction of the bias depends on the muscle and location being imaged.
Topics: Adult; Anal Canal; Cesarean Section; Endosonography; Female; Humans; Imaging, Three-Dimensional; Postpartum Period; Ultrasonography; Young Adult
PubMed: 25344221
DOI: 10.1007/s00192-014-2524-5 -
The American Journal of Case Reports May 2023BACKGROUND Anal stenosis due to anoderm scarring is usually caused by surgical trauma and decreases the patient's quality of life significantly. Even though mild anal...
BACKGROUND Anal stenosis due to anoderm scarring is usually caused by surgical trauma and decreases the patient's quality of life significantly. Even though mild anal stenosis can be treated non-surgically, surgical reconstruction is unavoidable for moderate to severe cases of anal stenosis, especially stenosis that causes severe anal pain and the inability to defecate. In this study, we report the diamond flap method in the treatment of anal stenosis. CASE REPORT A 57-year-old female patient reported difficulty and discomfort in defecation caused by anal stenosis 2 years after a hemorrhoidectomy surgery. On physical examination, a forceful dilatation was needed using the index finger; the size of the anal canal was precisely 6 mm, as measured by a hegar dilator. Laboratory tests results were normal. The patient underwent an anal repair and diamond flap procedure in which the scar tissue at 6 and 9 o'clock was excised and a diamond graft was incised carefully, with attention given to the vascular supply. Finally, the graft was sutured to the anal canal. After 2 days, the patient was discharged without any adverse event. Ten days after surgery, the diamond flap was in good condition and without any complications. The patient was then scheduled for further follow-up at the Digestive Surgery Division. CONCLUSIONS Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when the procedure is performed by an experienced surgeon. The diamond flap was the option used for anal stenosis treatment and had few complications.
Topics: Female; Humans; Middle Aged; Anal Canal; Hemorrhoidectomy; Constriction, Pathologic; Quality of Life; Surgical Flaps; Anus Diseases; Cicatrix; Treatment Outcome
PubMed: 37208893
DOI: 10.12659/AJCR.939444 -
Postgraduate Medical Journal Dec 2001Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply,... (Review)
Review
BACKGROUND
Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply, encouraging fissure healing. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpatient basis by applying a topical nitric oxide donor (for example, glyceryl trinitrate) or injecting botulinum toxin into the anal sphincter.
METHODS
A Medline database was used to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.
RESULTS
Review of the literature shows botulinum toxin injection to be more effective at healing chronic anal fissures than topical glyceryl trinitrate. Topical isosorbide dinitrate has not been directly compared with either of these two agents but has a healing rate approaching that of botulinum toxin injection. The main side effect of botulinum toxin injection is temporary faecal incontinence in approximately 2% of cases, whereas topical nitrates cause headaches in 20%-100% of cases. No long term side effects were identified with any of the medical treatments.
CONCLUSION
Chemical sphincterotomy is an effective treatment for chronic anal fissure and has the advantages over surgical treatment of avoiding long term complications (notably incontinence) and not requiring hospitalisation.
Topics: Administration, Topical; Anal Canal; Botulinum Toxins; Calcium Channel Blockers; Chronic Disease; Dilatation; Fissure in Ano; Humans; Nitric Oxide Donors; Nitroglycerin
PubMed: 11723312
DOI: 10.1136/pmj.77.914.753 -
Pediatrics and Neonatology Mar 2022
Topics: Anal Canal; Humans; Infant, Newborn; Infant, Newborn, Diseases; Perineum
PubMed: 34674971
DOI: 10.1016/j.pedneo.2021.09.002 -
BMC Women's Health Aug 2022The aim of this study was to examine whether OASIS, and its extent, can be confirmed or excluded using transperineal ultrasound (TPUS). A further objective of this study...
PURPOSE
The aim of this study was to examine whether OASIS, and its extent, can be confirmed or excluded using transperineal ultrasound (TPUS). A further objective of this study was to monitor the healing process over a period of 6 months and to establish a connection between the sonographic appearance of obstetric anal sphincter injury (OASIS) and anal incontinence.
MATERIALS AND METHODS
In this retrospective clinical study, women with OASIS who gave birth between March 2014 and August 2019 were enrolled. All the patients underwent TPUS 3 days and 6 months after delivery. A GE E8 Voluson ultrasound system with a 3.5-5 MHz ultrasound probe was used. The ultrasound images showed a third-degree injury, with the measurement of the width of the tear and its extent (superficial, partial, complete, EAS and IAS involvement). A positive contraction effect, a sign of sufficient contraction, was documented. Six months after delivery, a sonographic assessment of the healing (healed, scar or still fully present) was performed. A Wexner score was obtained from each patient. The patients' medical histories, including age, parity, episiotomy and child's weight, were added.
RESULTS
Thirty-one of the 55 recruited patients were included in the statistical evaluation. Three patients were excluded from the statistical evaluation because OASIS was excluded on TPUS 3 days after delivery. One patient underwent revision surgery for anal incontinence and an inadequately repaired anal sphincter injury, as shown sonographic assessment, 9 days after delivery. Twenty patients were excluded for other reasons. The results suggest that a tear that appears smaller (in mm) after 3 days implies better healing after 6 months. This effect was statistically significant, with a significance level of alpha = 5% (p = 0.0328). Regarding anal incontinence, women who received an episiotomy had fewer anal incontinence symptoms after 6 months. The effect of episiotomy was statistically significant, with a significance level of alpha = 5% (p = 0.0367).
CONCLUSION
TPUS is an accessible, non-invasive method for detecting, quantifying, following-up and monitoring OASIS in patients with third-degree perineal tears. The width, as obtained by sonography, is important with regard to the healing of OASIS. A mediolateral episiotomy seems to prevent anal incontinence after 6 months.
Topics: Anal Canal; Delivery, Obstetric; Episiotomy; Fecal Incontinence; Female; Humans; Infant, Newborn; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy; Retrospective Studies
PubMed: 35948903
DOI: 10.1186/s12905-022-01915-7 -
Neurogastroenterology and Motility Mar 2012Recto-anal inhibitory reflex (RAIR) is an integral part of normal defecation. The physiologic characteristics of RAIR along anal length and anterior-posterior axis are...
BACKGROUND
Recto-anal inhibitory reflex (RAIR) is an integral part of normal defecation. The physiologic characteristics of RAIR along anal length and anterior-posterior axis are unknown. The aim of this study was to perform topographic and vector-graphic evaluation of RAIR along anal canal using high definition manometry (HDM), and examine the role of various muscle components.
METHODS
Anorectal topography was assessed in 10 healthy volunteers using HDM probe with 256 sensors. Recto-anal inhibitory reflex data were analyzed every mm along the length of anal canal for topographic, baseline, residual, and plateau pressures during five mean volumes of balloon inflation (15 cc, 40 cc, 71 cc, 101 cc, 177 cc), and in 3D by dividing anal canal into 4 × 2.1 mm grids.
KEY RESULTS
Relaxation pressure progressively increases along anal canal with increasing balloon volume up to 71 cc and thereafter plateaus. In 3D, RAIR is maximally seen at the middle and upper portions of anal canal (levels 1.2-3.2 cm) and posteriorly. Peak residual pressure was seen at proximal anal canal.
CONCLUSIONS & INFERENCES
Recto-anal inhibitory reflex is characterized by differential anal relaxation along anterior-posterior axis, longitudinally along the length of anal canal, and it depends on the rectal distention volume. It is maximally seen at internal anal sphincter pressure zone. Multidimensional analyses indicate that external anal sphincter provides bulk of anal residual pressure. Our findings emphasize importance of sensor location and orientation; as anterior and more distal location may miss RAIR.
Topics: Adult; Anal Canal; Defecation; Female; Humans; Male; Manometry; Muscle, Smooth; Pressure; Rectum; Reflex
PubMed: 22235880
DOI: 10.1111/j.1365-2982.2011.01857.x -
The British Journal of Radiology Jul 2012Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of... (Comparative Study)
Comparative Study Review
Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity.
Topics: Anal Canal; Case-Control Studies; Endosonography; Fecal Incontinence; Female; Humans; Imaging, Three-Dimensional; Male; Perineum; Quality Control; Rectum; Sensitivity and Specificity; Vagina
PubMed: 22374273
DOI: 10.1259/bjr/27314678