Abstract
Assessment of complex sphincteric defects in patients with fecal incontinence by digital rectal examination and intraoperative dissection can be difficult in the presence of excessive scarring. Adjunctive investigation such as endoluminal ultrasound (ELUS) and needle electromyography (EMG) may provide objective evidence of the nature and extent of the sphincteric defects. In a series of 11 patients, ELUS of the anal canal with a 10-MHz transducer (focal zone of 1–4 cm) accurately detected defects in the external anal sphincter (EAS) in seven of seven patients, defects in the internal anal sphincter (IAS) in eight of eight patients, and integrity of both sphincters in two patients. These findings were confirmed by needle EMG of the EAS alone in five patients, by operative findings at a perineal sphincteroplasty operation in six patients, and by both in two patients. ELUS was associated with less pain than was needle EMG (pain score 4vs. 10, 10 being most painful) and provided high-resolution radial images of both the EAS and the IAS. Thus, ELUS seems preferable to EMG in mapping anal sphincteric defects and can be a useful anatomic adjunct to physiologic studies of anorectal function in patients with fecal incontinence.
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References
Browning GG, Motson RW, Henry MH. Combined sphincter repair and postanal repair for the treatment of complicated injuries to the anal sphincters. Ann R Coll Surg Engl 1988;70:324–8.
Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of fecal incontinence. Br J Surg 1991;78:312–4.
Tjandra JJ, Milsom JW, Stolfi VM,et al. Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor. Dis Colon Rectum 1992;35:465–70.
Law PJ, Talbot RW, Bartram CJ, Northover JM. Anal endosonography in the evaluation of perianal sepsis and fistula in ano. Br J Surg 1989;76:742–5.
Law PJ, Kamm MA, Bartram CI. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum 1990;33:370–3.
Bartolo DC, Jarratt JA, Read MG, Donnelly TC, Read NW. The role of partial denervation of the puborectalis muscle in idiopathic fecal incontinence. Br J Surg 1983;70:664–7.
Bartolo D. Electromyographic techniques. In: Smith LE, ed. Practical guide to anorectal testing. 1st ed. New York: Igaku-Shoin, 1990:151–60.
Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, May 2 to 7, 1993.
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Tjandra, J.J., Milsom, J.W., Schroeder, T. et al. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects. Dis Colon Rectum 36, 689–692 (1993). https://doi.org/10.1007/BF02238597
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DOI: https://doi.org/10.1007/BF02238597