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THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL ULTRASOUND GIVES A
NEW TREND IN COLORECTAL SURGERY
Dr. Kaspars SnipeRiga Eastern Clinical University Hospital (RAKUS), Riga, Latvia
3D TRUS and colorectal surgery
• The results of treatment depend on precise diagnose:
– rectal fistula
– anal sphincters lesions
– pelvic floor muscles damages
– ODS
– malignant rectum diseases
– others benign diagnoses (such endometrioses, presacral cyst)
History
• Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor. Wisser J, Schär G, Kurmanavicius J, Huch R, Huch A. Department of Obstetrics, University Hospital Zurich, Switzerland Ultraschall in der Medizin 1999 Feb;20(1):15-8
3D ultrasound can now be used to examine pelvic floor
anatomy and to detect changes associated with
trauma to the pelvic floor following vaginal delivery.
• Controversial issue:– 3D TRUS or MR
CONCLUSION: 3D EUS and endoanal MRI
are comparable for detecting EAS defects.
• Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging. West RL, Dwarkasing S, Briel JW, Hansen BE, Hussain SM, Schouten WR, Kuipers EJ. Int J Colorectal Dis. 2005 Jul;20(4):328-33. Epub 2005 Jan 22.
3D TRUS and colorectal surgery
3D US and colorectal surgery
• US examination for rectum and perineum:
– Anal canal
– Ampula of rectum (10-12-15cm)
– Dynamic transperineal investigation
Anal canal
• Assessment of muscles of anal canal
EAS
EAS
IAS
Anal canal
M.puborectalis
Ampula of rectum– Rectum wall and Pararectal tissue
Interface
Mucosae
Submucosae
Muscolaris propria
Perirectal fat
Dynamic transperineal investigation
• Relations between organs
– Push
– Strain
• Rectocele
• Enterocele
• Cystocele
Rectal fistula
• Pathology with high recurrent rate
• The providential point - detecting of internal opening
3D TRUS
3D TRUS
Anal sphincters lesions
• Trauma during delivery
• Iatrogenic lesions
• Where are the lesions?
• Is possible to reconstruct?
Anal sphincters lesionsWomen 32 y.o. After delivery
Reconstruction of anal canal
Reconstruction of anal canal
Reconstruction of anal canal
Perineum high 4.5 cm
Pelvic floor muscles damages
• Sphincter of urethra, vaginae and anal canal are on the one axis
Sphincter of urethra
Vaginae
Rectum
Pelvic floor muscles damages
• The deviation of rectum indirectly present the m.levator ani injury in opposite site
ODS (Obstructive defecation syndrome)
ODS (Obstructive defecation syndrome)
Malignant rectum diseases
• Invasion-muscolaris propria
• Local positive lymphnodes
Malignant rectum diseases
Malignant rectum diseases
Malignant rectum diseases
• Patient A.B. 80 y.o. T2N0M0
Others benign diagnoses
• Endometriosis
• Presacral cyst
Endometriosis
Endometriosis
Presacral cyst
Presacral cyst
Rectum-bar
Thank you!