By Giulio Aniello Santoro
New three-d endoanal and endorectal ultrasonographic and magnetic resonance imaging thoughts 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 properly evaluated, that's of basic value for choice making. due to advancements within the analysis of those problems, new kinds of remedy were constructed with higher end result for patients.
This ebook is geared toward common and colorectal surgeons, radiologists, gastroenterologists and gynecologists with a different curiosity during this box. it's also proper to every body who desires to increase their realizing of the elemental rules of pelvic ground problems.
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Extra info for Benign Anorectal Diseases Diagnosis with Endoanal and Endorectal Ultrasonography and New Treatment Options
The most promising new technique for the diagnosis of benign anorectal diseases, such as fistulas and sphincter tears, is three-dimensional (3-D) endorectal ultrasound. Three-dimensional imaging overcomes some of the difficulties and problems associated with conventional two-dimensional (2-D) endorectal ultrasound, which is usually done by real-time interpretation of 2-D crosssectional images. Although these images may provide valuable information, it is often difficult to interpret the images because the 3-D anatomy must be reconstructed mentally from multiple sectional images.
Schematic representation (c) Fig. 26. Sagittal image demonstrating the length of the perineal body (PB) that extends from the rectovaginal septum (RVS) to the external sphincter (EAS) Section III • State of the Art in Pelvic Floor Imaging 51 Fig. 27. The anococcygeal raphe (AR) is seen as a posteri- Fig. 28. Image at the superficial level demonstrating the or hypoechoic triangle subcutaneous external anal sphincter. The internal sphincter is absent at this level whereas both MRI methods enabled reliable measurement of all sphincter components.
Fibers from the LM run through the internal anal sphincter to form the muscularis submucosae ani (MSA) Coccygeus Iliococcygeus S3 S4 S5 PA b Fig. 2. The puboanalis (PA) rises from the medial border of the puborectalis (PR) ment derived from the endopelvic fascia, extends caudally as the conjoined longitudinal layer (CLL) between the external and internal anal sphincters and terminates at the anorectal junction [2–5] (Figs. 3 and 4). Its fibroelastic component permeating through the subcutaneous part of the external sphincter terminates in the perianal skin.
Benign Anorectal Diseases Diagnosis with Endoanal and Endorectal Ultrasonography and New Treatment Options by Giulio Aniello Santoro