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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!