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Anal endosonography: relationship with anal manometry and neurophysiologic tests.
Dis Colon Rectum. 1992 Oct; 35(10):944-9.DC

Abstract

Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery.

Authors+Show Affiliations

Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

1395981

Citation

Felt-Bersma, R J., et al. "Anal Endosonography: Relationship With Anal Manometry and Neurophysiologic Tests." Diseases of the Colon and Rectum, vol. 35, no. 10, 1992, pp. 944-9.
Felt-Bersma RJ, Cuesta MA, Koorevaar M, et al. Anal endosonography: relationship with anal manometry and neurophysiologic tests. Dis Colon Rectum. 1992;35(10):944-9.
Felt-Bersma, R. J., Cuesta, M. A., Koorevaar, M., Strijers, R. L., Meuwissen, S. G., Dercksen, E. J., & Wesdorp, R. I. (1992). Anal endosonography: relationship with anal manometry and neurophysiologic tests. Diseases of the Colon and Rectum, 35(10), 944-9.
Felt-Bersma RJ, et al. Anal Endosonography: Relationship With Anal Manometry and Neurophysiologic Tests. Dis Colon Rectum. 1992;35(10):944-9. PubMed PMID: 1395981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anal endosonography: relationship with anal manometry and neurophysiologic tests. AU - Felt-Bersma,R J, AU - Cuesta,M A, AU - Koorevaar,M, AU - Strijers,R L, AU - Meuwissen,S G, AU - Dercksen,E J, AU - Wesdorp,R I, PY - 1992/10/1/pubmed PY - 1992/10/1/medline PY - 1992/10/1/entrez SP - 944 EP - 9 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 35 IS - 10 N2 - Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/1395981/Anal_endosonography:_relationship_with_anal_manometry_and_neurophysiologic_tests_ DB - PRIME DP - Unbound Medicine ER -