By M. Pescatori, C.I. Bartram, A.P. Zbar, R.J. Nicholls

2-D and 3D anal ultrasound are one of the newest and complex instruments to be had for either the prognosis and the administration of anorectal ailments. they're neither pricey nor damaging for the sufferers and gradually changed anal mapping with EMG electrodes for the prognosis of sphincter's defects and anismus, which represents approximately 50% of the circumstances of continual constipation. Anal US could provide the clinician with beneficial info for either class, analysis and administration of anorectal sepsis, anal incontinence and anorectal-perineal continual discomfort. virtually any case provided during this Atlas indicates either imaging and medical photos, hence permitting either the radiologist and the clinician to evaluate the reliability of the examination and the result of the chosen treatment.

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35. A postanal chronic abscess is still evident after fistulectomy (arrow) Fig. 36. Transvaginal postfistulectomy ultrasound showing a left lateral perianal mixed hyperechoic area (arrow) mimicking a recurrent abscess M. Pescatori • S. Ayabaca • M. Spyrou • P. De Nardi Post Milligan-Morgan Hemorrhoidectomy, Stapled Hemorrhoidopexy and STARR Many local anal anomalies are demonstrable following hemorrhoid surgery, including deep seated perirectal sepsis, inadvertent sphincter injury and staple line disruption [39-42].

Anterior descent of an intestinal loop (arrow) interposed between the rectum and vagina evident anteriorly (arrowhead) Fig. 44. Low rectal intussusception as evident by a double layer recognizable on endosonography Fig. 43. Rectal internal intussusception in which a full thickness double layer is seen during straining 48 Chapter 2 Clinical Use of Two-Dimensional Endoanal and Transvaginal Sonography Solitary Rectal Ulcer Syndrome (SRUS) SRUS is a comparatively uncommon cause of evacuatory discomfort, often associated with specific psychological traits, rectal digitation and chronic constipation.

27f. The rectum is being resected Fig. 27g. The colon is ready for the colo-anal anastomosis 42 Chapter 2 Clinical Use of Two-Dimensional Endoanal and Transvaginal Sonography Postsurgical Miscellanea Post-surgical endoanal sonograms may be difficult to interpret, particularly where distinction is to be made between postoperative scarring and recrudescent sepsis [35]. Here images may be supplemented by Gadolinium-enhanced MR imaging (either surface or endoanal MR fistulography) which will assist in defining active collections and tracks [36, 37].

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