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Viszeralchirurgie 2002; 37(1): 17-22
DOI: 10.1055/s-2002-20326
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Endosonographie bei benignen proktologischen Erkrankungen

Endosonography in Benign Anorectal DisordersA.  Fürst, I.  Iesalnieks, H.  Spatz, L.  Hutzel
  • 1Klinik und Poliklinik für Chirurgie, Universitätsklinik Regensburg, 93042 Regensburg
    (Direktor: Prof. Dr. med. K.-W. Jauch)
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Publication History

Publication Date:
26 February 2002 (online)

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Zusammenfassung

Die anorektale Endosonographie ist bei verschiedenen Erkrankungen von Anus, Rektum und Beckenboden einsetzbar. Vergleichbar mit der Rektoskopie oder Proktoskopie ist die Endosonographie ein einfach durchzuführendes und valides Diagnostikum ohne wesentliche Patientenbelastung. Primär wurde die anorektale Endosonographie für das Tumorstaging evaluiert, jedoch nur kurze Zeit später wurde die Bedeutung dieses Untersuchungsverfahrens für gutartige anorektale Erkrankungen evident. Die Muskulatur des Analsphinkters kann klar dargestellt werden, der innere und der äußere Schließmuskel kann unterschieden werden. Weitere Beckenbodenstrukturen, wie die Puborektalisschlinge, der Levatormuskel und die Organe des kleinen Beckens lassen sich visualisieren. Eine besondere Bedeutung hat die Endosonographie in der Sphinkterdiagnostik, insbesondere in der Diagnostik von Sphinkterdefekten und in der postoperativen Kontrolle nach Schließmuskelrekonstruktion. Ein weiteres endosonographisches Indikationsfeld sind perianale Abszesse oder Analfisteln. Lokale Schmerzen oder Stenosen limitieren gelegentlich diese Untersuchungsmethode. Die anorektale Endosonographie stellt ein kostengünstiges, rasch verfügbares Diagnostikum für alle Arten anorektaler Erkrankungen dar. Ausbildung, Standardisierung und Qualitätskontrolle sind wichtig und bedürfen einer weiteren Evaluation.

Abstract

Anorectal endosonography may be used for diagnosing various disorders of the anus, rectum and pelvic floor. Similar to rectoscopy or proctoscopy anal endosonography is easy to perform and discomfort for the patient is low. Anorectal endosonography was first described in tumor staging, but short time later the value of endosonographic imaging became evident in benign anorectal disorders. Anal sphincter can be clearly visualized and distinction is possible between external and internal anal sphincter. Other pelvic structures can be visualized like M. levator or the puborectalis muscle. Endosonography is important in diagnosing sphincter pathologies, in localizing sphincter defects and controlling the result of sphincter repair. In anorectal or perineal sepsis, endosonography is a useful tool in defining localization of an abscess or a fistula tract. Limitations of endosonography are local pain or stenosis. Conclusion: Anal endosonography is a non expensive and useful diagnostic procedure for benign anorectal disorders. Teaching, training, standard investigation procedure and quality control in endosonography are important and require further evaluation.



Schlüsselwörter

Anale Endosonographie - Analsphinkter - Inkontinenz - Analfistel - Analabszess

Key words

Anal endosonography - Anal sphincter - Anal incontinence - Perianal fistula - Perianal abscess

Literatur

  • 1 Wild J J, Reid J M. Diagnostic use of ultrasound.  Br J Phys Med. 1956;  19 248
    PubMedGoogle Scholar
  • 2 Alzin H H, Kohlberger E, Schwaiger R, Alloussi S. Valeur de l'echographie endorectale dans la chirurgie du rectum.  Ann Radiol Paris. 1983;  26 334
    PubMedGoogle Scholar
  • 3 Dragsted J, Gammelgaard J. Endoluminal ultrasonic scanning in the evaluation of rectal cancer. A preliminary report of 13 cases.  Gastrointest Radiol. 1983;  8 367
    CrossrefPubMedGoogle Scholar
  • 4 Hildebrandt U, Feifel G, Zimmermann F A, Goebbels R. Significant improvement in clinical staging of rectal carcinoma with a new intrarectal ultrasound scanner.  J Exp Clin Cancer Res. 1983;  2 53
    PubMedGoogle Scholar
  • 5 Sailer M, Leppert R, Fuchs K H, Thiede A. Die endorektale Sonographie.  Coloproctology. 1995;  17 149-157
    PubMedGoogle Scholar
  • 6 Law P J, Bartram C I. Anal endosonography: technique and normal anatomy.  Gastrointest Radiol. 1989;  14 349-353
    CrossrefPubMedGoogle Scholar
  • 7 Eckardt V F, Jung B, Fischer B, Lierse W. Anal endosonography in healthy subjects and patients with idiopathic fecal incontinence.  Dis Colon Rectum. 1994;  37 235-242
    PubMedGoogle Scholar
  • 8 Nielsen M B, Pedersen J F, Hauge C, Rasmussen O O, Christiansen J. Endosonography of the anal sphincter: findings in healthy volunteers.  Am J Roentgenol. 1991;  157 1199-1202
    PubMedGoogle Scholar
  • 9 Tjandra J J, Milsom J W, Stolfi V M. et al . Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor.  Dis Colon Rectum. 1992;  35 465-470
    PubMedGoogle Scholar
  • 10 Nielsen M B, Hauge C, Rasmussen O O, Sorensen M, Pedersen J F, Christiansen J. Anal sphincter size measured by endosonography in healthy volunteers. Effect of age, sex and parity.  Acta Radiol. 1992;  33 453-456
    PubMedGoogle Scholar
  • 11 Sultan A H, Nicholls R J, Kamm M A, Hudson C N, Beynon J, Bartram C I. Anal endosonography and correlation with in vitro and in vivo anatomy.  Br J Surg. 1993;  80 508-511
    PubMedGoogle Scholar
  • 12 Papachrysostomou M, Pye S D, Wild S R, Smith A N. Anal endosonography in asymptomatic subjects.  Scand J Gastroenterol. 1993;  28 551-556
    PubMedGoogle Scholar
  • 13 Gerdes B, Kohler H H, Zielke A, Kisker O, Barth P J, Stinner B. The anatomical basis of anal endosonography - a study in postmortem specimens.  Surg Endosc. 1997;  11 986-990
    CrossrefPubMedGoogle Scholar
  • 14 Poen A C, Felt-Bersma R JF. Cuesta MA, Meuwissen SGM. Normal values and reproducibility of anal endosonographic measurements.  Eur J Ultrasound. 1997;  6 103-110
    CrossrefPubMedGoogle Scholar
  • 15 Poen A C, Felt-Bersma R JF. Endosonography in benign anorectal disease: an overview.  Scand J Gastroenterol. 1999;  34 (Suppl 230) 40-48
    CrossrefPubMedGoogle Scholar
  • 16 Sultan A H, Kamm M A, Hudson C N, Nicholls J R, Bartram C I. Endosonography of the anal sphincters: normal anatomy and comparison with manometry.  Clin Radiol. 1994;  49 368-374
    PubMedGoogle Scholar
  • 17 Nielsen M B. Endosonography of the anal sphincter muscles in healthy volunteers and in patients with defecation disorders.  Acta Radiol Suppl. 1998;  416 1-21
    PubMedGoogle Scholar
  • 18 Papachrysostomou M, Pye S D, Wild S R, Smith A N. Significance of the thickness of the anal sphincter with age and its relevance in faecal incontinence.  Scand J Gastroenterol. 1994;  29 710-714
    PubMedGoogle Scholar
  • 19 Nielsen M B, Pedersen J F. Changes in the anal sphincter with age. An endosonographic study.  Acta Radiol. 1996;  37 357-361
    PubMedGoogle Scholar
  • 20 Schäfer R, Heyer T, Gantke B. et al . Anal endosonography and manometry: comparison in patients with defecation problems.  Dis Colon Rectum. 1997;  40 293-297
    PubMedGoogle Scholar
  • 21 Oh C, Kark A E. Anatomy of the external anal sphincter.  Br J Surg. 1972;  59 717
    PubMedGoogle Scholar
  • 22 Ayoub S F. Anatomy of the external anal sphincter in man.  Acta Anat. 1979;  105 25
    PubMedGoogle Scholar
  • 23 Dalley A F. The riddle of the sphincters. The morpho-physiology of the anorectal mechanism reviewed.  Am Surg (Published erratum appears in Am Surg 1987;53:398). 1987;  53 298
    PubMedGoogle Scholar
  • 24 Golligher J. Surgery of the anus, rectum and colon. 5th edn. Bailliére Tindall London; 1984
    Google Scholar
  • 25 Burnett S J, Bartram C I. Endosonographic variations in the normal internal anal sphincter.  Int J Colorectal Dis. 1991;  6 2-4
    CrossrefPubMedGoogle Scholar
  • 26 Gantke B, Schäfer A, Enck P, Lübke H J. Sonographic manometric and myographic evaluation of the anal sphincters morphology and function.  Dis Colon Rectum. 1993;  36 1037-1041
    PubMedGoogle Scholar
  • 27 Klosterhalfen B, Offner F, Topf N, Vogel P, Mittermayer C. Sclerosis of the internal anal sphincter - A process of aging.  Dis Colon Rectum. 1990;  33 606-609
    PubMedGoogle Scholar
  • 28 Law P J, Bartram C I. Anal endosonography: technique and normal anatomy.  Gastrointest Radiol. 1989;  14 349-353
    CrossrefPubMedGoogle Scholar
  • 29 Lunniss P J, Phillips R. Anatomy and function of the anal longitudinal muscle.  Br J Surg. 1992;  79 882-884
    PubMedGoogle Scholar
  • 30 Beynon J, Foy D MA, Channer J L. The endosonic appearances of normal colon and rectum.  Dis Colon Rectum. 1986;  29 810
    PubMedGoogle Scholar
  • 31 Kumar A, Scholefield J H. Endosonography of the anal canal and rectum.  World J Surg. 2000;  24 208-215
    CrossrefPubMedGoogle Scholar
  • 32 Parks A G, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse.  Gut. 1977;  18 656-665
    CrossrefPubMedGoogle Scholar
  • 33 Snooks S J, Swash M, Setchell M, Henry M M. Injury to innervation of pelvic floor sphincter musculature in childbirth.  Lancet. 1984;  2 546-550
    PubMedGoogle Scholar
  • 34 Sultan A H, Kamm M A, Hudson C N, Thomas J M, Bartram C I. Anal-sphincter disruption during vaginal delivery.  N Engl J Med. 1993;  329 1905-1911
    CrossrefPubMedGoogle Scholar
  • 35 Kamm M A. Obstetric damage and fecal incontinence.  Lancet. 1994;  344 730-733
    CrossrefPubMedGoogle Scholar
  • 36 Burnett S J, Spence-Jones C, Speakman C T, Kamm M A, Hudson C n, Bartram C I. Unsuspected sphincter damage following childbirth revealed by anal endosonography.  Br J Radiol. 1991;  64 225-227
    CrossrefPubMedGoogle Scholar
  • 37 Law P J, Kamm M A, Bartram C I. Anal endosonography in the investigation of fecal incontinence.  Br J Surg. 1991;  78 312-314
    PubMedGoogle Scholar
  • 38 Deen K I, Kumar D, Williams J G, Olliff J, Keighley M. The prevalence of anal sphincter defects in fecal incontinence: a prospective endosonic study.  Gut. 1993;  34 685-688
    PubMedGoogle Scholar
  • 39 Farouk R, Bartolo D C. The use of endoluminal ultrasound in the assessment of patients with fecal incontinence.  J R Coll Surg Edinb. 1994;  39 312-318
    PubMedGoogle Scholar
  • 40 Felt-Bersma R J, van Baren R, Koorevaar M, Strijers R L, Cuesta M A. Unsuspected sphinkter defects shown by anal endosonography after anorectal surgery. A prospective study.  Dis Colon Rectum. 1995;  38 249-253
    CrossrefPubMedGoogle Scholar
  • 41 Sultan A H, Kamm M A, Nicholls R J, Bartram C I. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy.  Dis Colon Rectum. 1994;  37 1031-1033
    PubMedGoogle Scholar
  • 42 Farouk R, Drew P, Duthie G, Lee P, Moson J. Disruption of the internal anal sphinkter can occur after transanal stapling.  Br J Surg. 1996;  83 1400
    PubMedGoogle Scholar
  • 43 Silvis R, van Eekelen J W, Delemarre J B, Gooszen H G. Endosonography of the anal sphincter after ileal pouch-anal anastomosis. Relation with anal manometry and fecal continence.  Dis Colon Rectum. 1995;  38 383-388
    PubMedGoogle Scholar
  • 44 Speakman C T, Burnett S J, Kamm M A, Bartram C I. Sphincter injury after anal dilatation demonstrated by anal endosonography.  Br J Surg. 1991;  78 1429-1430
    PubMedGoogle Scholar
  • 45 Nielsen M B, Rasmussen O O, Pedersen J F, Christiansen J. Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano: an endosonographic study.  Dis Colon Rectum. 1993;  36 677-680
    PubMedGoogle Scholar
  • 46 Vaizey C J, Kamm M A, Bartram C I. Primary degeneration of the anal sphincter as a cause of passive fecal incontinence.  Lancet. 1997;  349 612-615
    CrossrefPubMedGoogle Scholar
  • 47 Engel A F, Kamm M A, Talbot I C. Progressive systemic sclerosis of the internal anal sphincter leading to passive fecal incontinence.  Gut. 1994;  35 857-859
    PubMedGoogle Scholar
  • 48 Eckardt V F, Jung B, Fischer B, Lierse W. Anal endosonography in healthy subjects and patients with idiopathic fecal incontinence.  Dis Colon Rectum. 1994;  37 235-242
    PubMedGoogle Scholar
  • 49 Poen A C, Felt-Bersma R JF, Cuesta M A, Meuwissen S GM. Vaginal endosonography of the anal sphincter complex is important in the assessment of fecal incontinence and perianal sepsis.  Br J Surg. 1998;  85 359-363
    CrossrefPubMedGoogle Scholar
  • 50 Cheong D, Nogueras J J, Wexner S D, Jagelman D G. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide.  Dis Colon Rectum. 1993;  36 1158-1160
    PubMedGoogle Scholar
  • 51 Poen A C, Felt-Bersma R JF, Eijsbouts Q AJ, Cuesta M A, Meuwissen S GM. Hydrogen peroxide enhancement transanal ultrasound in the diagnosis of fistula-in-ano. Dis Colon Rectum. In press
    Google Scholar
  • 52 Iroatulam A, Nogueras J, Chen H. Accuracy of endoanal ultrasonography in evaluating anal fistulas.  Gastroenterology. 1997;  112 (Suppl) A1450
    PubMedGoogle Scholar
  • 53 Wijers O, Tio T, Tygtat G. Ultrasonography and endosonography in the diagnosis and management of inflammatory bowel disease.  Endoscopy. 1992;  24 559-564
    PubMedGoogle Scholar
  • 54 Tio T L, Mulder C, Wijers O B, Sars P, Tytgat G. Endosonography of peri-anal and peri-colorectal fistula and/or abscess in Crohn's disease.  Gastrointest Endosc. 1990;  36 331-336
    CrossrefPubMedGoogle Scholar
  • 55 Schratter S A, Lochs H, Handl Z L, Tscholakoff D, Schratter M. Endosonographic features of the lower pelvic region in Crohn's disease.  Am J Gastroenterol. 1993;  88 1054-1057
    PubMedGoogle Scholar
  • 56 Hussain S, Stoker J, Schouten W, Hop W, Lameris J. Fistula in ano: endoanal sonography versus endoanal MR imaging in classification.  Radiology. 1996;  200 475-481
    PubMedGoogle Scholar
  • 57 Lunniss P J, Barker P G, Sultan A H. Magnetic resonance imaging of fistula in ano.  Dis Colon Rectum. 1994;  37 708-718
    PubMedGoogle Scholar
  • 58 Lunniss P J, Armstromg P, Barkler P G, Reznek R H, Phillips R K. Magnetic resonance imaging of anal fistulae.  Lancet. 1992;  340 394
    CrossrefPubMedGoogle Scholar
  • 59 Farouk R, Monson J, Duthie G. Technical failure of lateral sphincterotomy for the treatment of chronic anal fissure: a study using endoanal ultrasonography.  Br J Surg. 1997;  84 84-85
    PubMedGoogle Scholar
  • 60 Nielsen M B, Hauge C, Pedersen J F, Christiansen J. Endosonographic assessment of the anal sphincter after surgical reconstruction.  Dis Colon Rectum. 1994;  37 434(Paper VII)
    PubMedGoogle Scholar
  • 61 Kamm M A, Hoyle C H, Burleigh D E. Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition.  Gastroenterology. 1991;  100 805-810
    PubMedGoogle Scholar
  • 62 Nielsen M B, Rasmussen O O, Pedersen J F, Christiansen J. Anal endosonographic findings in patients with obstructed defecation.  Acta Radiol. 1993;  34 35-38
    PubMedGoogle Scholar
  • 63 Solomon M J, Mc Leod R S, Cohen E K, Cohen Z. Anal wall thickness under normal and inflammatory conditions of the anorectum as determined by endoluminal ultrasonography.  Am J Gastroenterol. 1995;  90 547-548
    PubMedGoogle Scholar
  • 64 Poen A C, Felt-Bersma R JF, Cuesta M A, Meuwissen S GM. Internal hemorrhoids are associated with endosonographic thickening of the submucosa and hypertrophy of the external anal sphincter.  Gastroenterology. 1996;  110 A736
    PubMedGoogle Scholar
  • 65 Eckardt V F, Dodt O, Kanzler G, Bernhard G. Anorectal function and morphology in patients with sporadic proctalgia fugax.  Dis Colon Rectum. 1996;  39 755-762
    PubMedGoogle Scholar
  • 66 Felt-Bersma R J, Cuesta M A, Koorevaar M, Strijers R L, Meuwissen S G, Dercksen E J, Wesdorp R I. Anal ensosonography: relationship with anal manometry and neurophysiologic tests.  Dis Colon Rectum. 1992;  35 944-949
    PubMedGoogle Scholar
  • 67 Deen K I, Kumar D, Williams J G, Olliff J, Keighley M R. Anal sphincter defects. Correlation between endoanal ultrasound and surgery.  Ann Surg. 1993;  218 201-205
    CrossrefPubMedGoogle Scholar
  • 68 Aubert A, Mosnier H, Amarenco G, Contou J F, Gallot D, Guivarch M, Malafosse M. Incontinences anales post-chirurgicales ou traumatique. Etude prospective de 40 malades explores par echographie endorectale et electromyographie.  Gastroenterol Clin Biol. 1995;  19 598-603
    PubMedGoogle Scholar
  • 69 Felt-Bersma R J, Cuesta M A, Koorevaar M. Anal sphincter repair improves anorectal function and endosonographic image. A prospective clinical study.  Dis Colon Rectum. 1996;  39 878-885
    CrossrefPubMedGoogle Scholar
  • 70 Romano G, Rotondano G, Esposito P, Pellecchia L, Novi A. External anal sphincter defects: correlation between preoperative anal endosonography and intraoperative findings.  Br J Radiol. 1996;  69 6-9
    PubMedGoogle Scholar
  • 71 Meyenberger C, Bertschinger P, Zala G F, Buchmann P. Anal sphincter defects in fecal incontinence: Correlation between endosonography and surgery.  Endoscopy. 1996;  28 217-224
    PubMedGoogle Scholar

Dr. med. Alois Fürst

Klinik für Chirurgie, Universitätsklinik

93042 Regensburg

Phone: 0941/944-0

Fax: 0941/944-6802

Email: alois.fuerst@klinik.uni-regensburg.de