INTRODUCTION: Benign and malignant conditions of the anus, perianal space, and rectum encompass various disorders: perianal abscesses and fistulas, anal fissures, hemorrhoids, incontinence, defecation disorder, rectovaginal and rectovesical fistulas, rectal prolapse, neoplasms of the anal canal and rectum. Very often patients have more than one condition. The high prevalence of benign anal disorders makes them socially significant. In the last two decades, a lot of new diagnostic methods were introduced. This has improved the understanding of the pathogenesis of these conditions. Endoanal and endorectal endoscopic ultrasound has become an important part of the evaluation of anal and rectal disease. This method is widely preferred because of its low price, accessibility, lack of complications, and good tolerance to the examination without sedation.
MATERIALS AND METHODS: Thirty patients have undergone endorectal ultrasound (ERUS) examination, from April 2023 to June 2023. All ERUS examinations were performed using 3D 20R3 and 3D X14L4 endorectal transducers connected to BK 3000 Ultrasound System (BK Medical Aps, Denmark).
RESULTS: The mean age was 48.4. Eighteen patients were male (60%). The main clinical indication was an evaluation of perianal abscesses and fistulas or neoplasms. Nine of the examinations, or 30%, were performed for anal and rectal tumors. Perianal abscesses were identified in 7 cases (23%); 5 patients had anal fissures; 4 had perianal fistulas (13%); 1 had a rectovaginal fistula. The rest of the patients had hemorrhoidal disease.
CONCLUSION: Endorectal and endoanal ultrasound is a sensitive and reliable method for the assessment of the anatomical structures and diagnosis of benign and malignant diseases of the anus, perianal space, and rectum.
Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantages. Ultrasonography. 2015;34(1):19-31. doi: 10.14366/usg.14051.
Saranovic D, Barisic G, Krivokapic Z, Masulovic D, Djuric-Stefanovic A. Endoanal ultrasound evaluation of anorectal diseases and disorders: technique, indications, results and limitations. Eur J Radiol. 2007;61(3):480-9. doi: 10.1016/j.ejrad.2006.07.033.
Saftoiu A, Gheonea DI. Tridimensional (3D) endoscopic ultrasound: a pictorial review. J Gastrointestin Liver Dis 2009;18(4):501-5.
Samdani T, Garcia-Aguilar J. Imaging in rectal cancer: magnetic resonance imaging versus endorectal ultrasonography. Surg Oncol Clin N Am. 2014;23:59-77.
Bhutani MS. Recent developments in the role of endoscopic ultrasonography in diseases of the colon and rectum. Curr Opin Gastroenterol. 2007;23(1):67-73. doi: 10.1097/MOG.0b013e328011630b.
Engin G. Endosonographic imaging of anorectal diseases. J Ultrasound Med. 2006;25(1):57-73. doi: 10.7863/jum.2006.25.1.57.
Tamandl D, Mang T, Ba-Ssalamah A. Imaging of colorectal cancer - the clue to individualized treatment. Innov Surg Sci. 2018;3(1):3-15. doi: 10.1515/iss-2017-0049.
Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population- based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9. doi: 10.3322/caac.21388.
Chand M, Brown G. Pre-operative staging of rectal cancer: MRI or ultrasound? Semin Colon Rectal Surg. 2013;24:114-8.
Van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon and rectum. Eur J Cancer. 2014;50(1):1 e1–34. doi: 10.1016/j.ejca.2013.06.048.
Hunerbein M, Pegios W, Rau B, Vogl TJ, Felix R, Schlag PM. Prospective comparison of endorectal ultrasound, three- dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors: preliminary results. Surg Endosc. 2000;14(11):1005-9. doi: 10.1007/s004640000345.
Otto SD, Lee L, Buhr HJ, Frericks B, Hocht S, Kroesen AJ. Staging anal cancer: prospective comparison of transanal endoscopic ultrasound and magnetic resonance imaging. J Gastrointest Surg. 2009;13(7):1292-8. doi: 10.1007/s11605-009-0870-2.
Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.
de Miguel Criado J, del Salto LG, Rivas PF, del Hoyo LF, Velasco LG, de las Vacas MI, et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics. 2012;32(1):175-94. doi: 10.1148/rg.321115040.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in ano. Br J Surg. 1976;63(1):1-12. doi: 10.1002/bjs.1800630102.
Felt-Bersma RJ. Endoanal ultrasound in perianal fistulas and abscesses. Dig Liver Dis. 2006;38(8):537-43. doi: 10.1016/j.dld.2006.02.016.
Sharma A, Yadav P, Sahu M, Verma A. (2020). Current imaging techniques for evaluation of fistula in ano: a review. Egypt J Radiol Nucl Med. 2020;51:130. doi: 10.1186/s43055-020-00252-9
Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55(5):576-85. doi: 10.1097/DCR.0b013e318249d26c.
Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB. Endoanal ultrasound-guided surgery for anal fistula. Endoscopy. 2005;37(8):722-8. doi: 10.1055/s-2005-870155.
Fuchsjager MH, Maier AG. Imaging fecal incontinence. Eur J Radiol 2003;47(2):108-16. doi: 10.1016/s0720-048x(03)00163-3.
Mansi S, Vaz K, Santucci NR, El-Chammas K, Graham K, Rosen NG, Kaul A. Anal sphincter defect and fecal incontinence. JPGN Rep. 2022;3(4):e254. doi: 10.1097/PG9.0000000000000254.
Yin HQ, Wang C, Peng X, Xu F, Ren YJ, Chao YQ, et al. Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula. BMC Med Imaging. 2016;16:29. doi: 10.1186/s12880-016-0131-2.
Pastor DM, Lowry AC. Surgical management of rectovaginal fistula. Semin Colon Rectal Surg. 2014;25(4):221–7.
Email this article (Login required) 
