PURPOSE: To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. MATERIALS AND METHODS: Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. RESULTS: Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not defective. Myogenic and neurogenic incontience showed different findings (p=0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. CONCLUSION: Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.
Abscess ; Diagnosis ; Fecal Incontinence ; Fistula ; Humans ; Muscles ; Pudendal Nerve ; Rectal Fistula ; Retrospective Studies ; Ultrasonography*

OBJECTIVE: This study was designed to assess the usefulness of transperineal ultrasonography (US) for the determination of imperforate anus (IA) type. MATERIALS AND METHODS:From January 2000 to December 2004, 46 of 193 patients with an IA underwent transperineal US prior to corrective surgery. Sonographic findings were reviewed to identify the presence of internal fistulas and to determine "distal rectal pouch to perineum (P-P)" distances. IA types were determined based on the sonographic findings, and the diagnostic accuracy of transperineal US was evaluated based on surgical findings. RESULTS: Of the 46 patients, 17 patients were surgically confirmed as having a high-type IA, three patients were confirmed as having an intermediate-type IA and 26 patients were confirmed as having a low-type IA. The IA type was correctly diagnosed by the use of transperineal US in 39 of the 46 patients (85%). In 14 of the 17 patients with a high-type IA, internal fistulas were correctly identified. All cases with a P-P distance > 16 mm were high-type IAs and all cases with a P-P distance < 5 mm were low-type IAs. CONCLUSION: Transperineal US is a good diagnostic modality for the identification of internal fistulas in cases of high-type IA and for defining the IA level.
Anus, Imperforate/classification/surgery/*ultrasonography ; Female ; Fistula/ultrasonography ; Humans ; Infant, Newborn ; Male ; Rectal Fistula/ultrasonography ; Ultrasonography/methods ; Urinary Bladder Diseases/ultrasonography

Transrectal ultrasonography (TRUS) has been widely accepted as a popular imaging modality for evaluating the lower rectum, anal sphincters, and pelvic floor in patients with various anorectal diseases. It provides excellent visualization of the layers of the rectal wall and of the anatomy of the anal canal. TRUS is an accurate tool for the staging of primary rectal cancer, especially for early stages. Although magnetic resonance imaging is a modality complementary to TRUS with advantages for evaluating the mesorectum, external sphincter, and deep pelvic inflammation, three-dimensional ultrasonography improves the detection and characterization of perianal fistulas and therefore plays a crucial role in optimal treatment planning. The operator should be familiar with the anatomy of the rectum and pelvic structures relevant to the preoperative evaluation of rectal cancer and other anal canal diseases, and should have technical proficiency in the use of TRUS combined with an awareness of its limitations compared to magnetic resonance imaging.
Anal Canal ; Fistula ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Pelvic Floor ; Rectal Neoplasms ; Rectum ; Ultrasonography*

PURPOSE: This study was performed to evaluate the surgical and the oncological outcomes of preoperative radio-chemotherapy (PRCT) in patients with low rectal cancer. METHODS: We reviewed 26 (M:F=17:9) patients who underwent PRCT between September 1999 and December 2001. Inclusion criteria were lower rectal cancer (4~5 cm from AV), more than T3 or N1 in preoperative staging using CT scan and transrectal ultrasound, and no distant metastasis. Patients received a mean of 47.3 (45.0 ~56.0) Gy of radiation therapy for 5 weeks and concomitant intravenous or oral chemotherapy using 5 FU and leucovorin. Surgery was performed in about 5~6 weeks after completion of radiotherapy. Total mesorectal excision and autonomic nerve preservation was the routine procedure. Adverse events during PRCT were assessed according to the NCI Common Toxicity Criteria (version 2.0, 1997). RESULTS: The mean age was 49 (28~65) years old. The median follow-up period was 31 (20~44) months. The most frequent adverse event was diarrhea (8, 30.8%), followed by nausea and vomiting (5, 19.2%), dermatitis (5, 19.2%), anemia (4, 15.4%), leucopenia (2, 7.7%), and mucositis (1, 3.8%). The mean location of the tumor was elevated from 4.5 cm to 5.5 cm after PRCT. Downstaging of the tumor was identified in 69.2% of the T-level and 63.2% of the N-level. The serum CEA level was decreased from 14.5+/-5.0 ng/ml to 3.5+/-0.5 ng/ml after PRCT (P=0.034). A sphincter-saving resection (SSR) was possible in 16 cases (61.5%). The mean distal resection margin was 2.2+/-0.7 cm in SSRs. Small bowel obstruction was the most frequent complication (6 cases, 23.1%), followed by hydronephrosis 2 (7.7%), a recto-vaginal fistula (1, 3.8%), and a recto-vesical fistula (1, 3.8%). There were no mortalities. Five (19.2%) recurrences developed in distant area, one (3.8%) in a local area, and one in both a local and a distant area. The patients with N-level downstaging revealed a significantly low recurrence rate (8.3% vs. 57.1%; P=0.03). CONCLUSIONS: PRCT can be performed with an acceptable toxicity and complication rate. It is effective in downstaging of the tumor and in increasing the sphincter-saving rate. However, a prospective, randomized, controlled trial should be performed to prove the oncological benefit.
Anemia ; Autonomic Pathways ; Dermatitis ; Diarrhea ; Drug Therapy ; Fistula ; Follow-Up Studies ; Humans ; Hydronephrosis ; Leucovorin ; Mortality ; Mucositis ; Nausea ; Neoplasm Metastasis ; Preoperative Care ; Radiotherapy ; Rectal Neoplasms ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

Fecal incontinence is a disabling condition with devastating psychosocial impact due to diverse etiology. This study was performed to assess various causes of fecal incontinence, clinical evaluation, and adequate surgical treatment. METHODS: Eighty patients presenting fecal incontinence during July 1989 and June 1997 were included. They were evaluated by clinical parameters and physiologic tests including the defecography, electromyography, transanal ultrasonography, and anorectal manometry. Surgery was performed in 31 patients based on those evaluation. Pre- and post-operative comparison of manometric findings, clinical assessment, incontinence score, and the outcome of surgery were assessed. Mean postoperative follow-up was 22 (2~84) months. RESULTS: Inappropriate anal surgery was the most common cause, and then injuries during delivery, trauma, rectal prolapse, and hysterectomy in descending order. Defecography was performed in 21 patients and mean values of anorectal angles were 115+/-15degrees at rest, 98+/-18degrees during squeezing, and 136+/-10degrees during push. Electromyography was performed in 8 patients showing pudendal neuropathy in 2, bilateral lumbosacral polyradiculopathy in 4, and normal finding in 2 patients, respectively. Transanal ultrasonography was performed in 33 patients and 22 among them showed finding of an injury of the anal sphincters. Surgery was performed in 31 patients due to anal sphincter damage, rectovaginal fistula, and anal stricture in descending order. Type of surgery was determined by respective cause: plication, triple repair (sphincteroplasty, anoplasty, perineorrhaphy), and posterior rectopexy in descending order. Nerve preserving graciloplasty was performed in a 12 year-old girl who had severe defect of the anal sphincters by traffic accident, showing sound recovery with a good functional outcome. Although there was no significant difference of manometric variables between pre- and post-operative periods, sphincter length, and maximum resting and squeezing pressure, revealed an increasing tendency postoperatively. According to the clinical assessment between pre- and post-operative periods, urgency to evacuate, soiling, sensation on defecation, and quality discrimination were significantly improved postoperatively (P<0.01). Incontinence score was markedly decreased from 10.6+/-6.1 during preoperative period to 2.9+/-4.7 during postoperative period (P<0.01). Eighty one percent of the patients undergone surgery experienced a significant symptomatic improvement. CONCLUSIONS: According to the analysis of the causes of fecal incontinence, inappropriate anal surgery, injuries during delivery, and trauma were main causes. Adequate application of physiologic tests, such as, defecography, electromyography, transanal ultrasonography, and anorectal manometry, were helpful in determining treatment modality and types of surgery. We got satisfactory results with adequate surgery based on the physiologic tests.
Accidents, Traffic ; Anal Canal ; Child ; Constriction, Pathologic ; Defecation ; Defecography ; Discrimination (Psychology) ; Electromyography ; Fecal Incontinence* ; Feces ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Manometry ; Polyradiculopathy ; Postoperative Period ; Preoperative Period ; Pudendal Neuralgia ; Rectal Prolapse ; Rectovaginal Fistula ; Sensation ; Soil ; Ultrasonography