By Giulio Aniello Santoro
New third-dimensional endoanal and endorectal ultrasonographic and magnetic resonance imaging suggestions have given higher perception into the advanced anatomy of the pelvic flooring and its pathologic amendment in benign anorectal illnesses. Obstetrical occasions resulting in fecal incontinence in women, the connection among fistulous tracks and the sphincter advanced, and mechanisms of obstructed defecation syndrome can now be safely evaluated, that's of basic significance for choice making. due to advancements within the analysis of those issues, new varieties of remedy were constructed with larger final result for patients.
This publication is aimed toward common and colorectal surgeons, radiologists, gastroenterologists and gynecologists with a unique curiosity during this box. it's also appropriate to all people who desires to enhance their knowing of the basic ideas of pelvic flooring issues.
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Extra info for Benign Anorectal Diseases Diagnosis with Endoanal and Endorectal Ultrasonography and New Treatment Options
The deep part is integral with the puborectalis. Posteriorly, there is some ligamentous attachment; anteriorly, some fibers are circular and some decussate into the deep transverse perineii. 2. The superficial part has a very broad attachment to the underside of the coccyx via the anococcygeal ligament. Anteriorly, there is a division into circular fibers and a decussation to the superficial transverse perineii. Section III • State of the Art in Pelvic Floor Imaging 37 Deep Superficial Subcutaneus Fig.
Volume Render Mode” is a special feature that successfully can be applied to high-resolution 3-D data volumes. Imaging processing includes maximum intensity, minimum intensity, and summed voxel projections combined with positional or intensity weighting. This technique changes the depth information of 3-D data volume so information inside the cube to some extend is reconstructed. Most processes, particularly smoothing, decrease the information. This may be desirable in some cases. If an image is cluttered with noise, the observer’s visual perception may be overloaded, and detail may consequently be missed.
Endosonography largely overestimates the size of the EAS due to its failure to recognize and separate the CLL. The EAS and the CLL contain large amounts of fat and fibrous tissue, which lead to similar echogenicities of both structures  (Fig. 20). Ultrasound imaging of the anus can be divided into three levels: high, mid, and low portions [3, 19] (Fig. 21). The level refers to the following anatomical structures: 1. High: the sling of the puborectalis and the deep part of the external sphincter; Ischiocavernosus muscle Vagina Ischiopubic ramus Inferior fascia of urogenital diaphragm Bulbocavernosus muscle Gluteus maximus muscle Superficial transverse perineal muscle External sphincter of anal canal Levator ani muscle Anococcygeal ligament Fig.