Anal endosonography using a specially designed hard cone attachment to a radial 7-MHz probe has been performed in 26 normal patients -3 patients following lateral anal sphincterotomy, 1 patient undergoing electromyophysiological mapping of the external and sphincter, and in 2 resected specimens. The examinations were rapid, simple, and well tolerated, and they provided high-resolution images of the five layers of the anal canal: mucosa, submucosa, internal and sphincter, intersphincteric plane, and external anal sphincter. Views of the ischiorectal fossa were limited. The configuration of the anterior part of the external anal sphincter differed between males and females.

Anal endosonography has been performed in 22 patients with fistula in ano and perianal sepsis and compared with the operative findings. Using a special hard cone attachment to a radial 7 MHz probe the examination was well tolerated, rapid and generally accurate, detecting two unsuspected foreign bodies and all seven complicated fistula in ano preoperatively.

Forty-four consecutive patients with incontinence of solid stool of traumatic or idiopathic aetiology were examined by anal endosonography and standard anorectal physiology tests. Anal endosonography showed an external anal sphincter defect in four out of 11 (36 per cent) patients with idiopathic (neurogenic) incontinence. In the remaining seven patients both parts of the sphincter were intact and a linear relationship was found between the resting anal canal pressure and the endosonographic thickness of the internal anal sphincter. Twenty-eight out of 33 (85 per cent) patients with incontinence of traumatic origin had external sphincter defects, confirmed by concentric needle electromyogram mapping in the 19 patients in whom this was performed. Eleven of these 28 (39 per cent) patients also had disruption of the internal sphincter. Anal endosonography has revealed significant abnormalities in patients with faecal incontinence and has a complementary role to anorectal physiology in the routine investigation of these patients.

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