Current applications of transperineal ultrasound in gastroenterology

Abstract

Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and noninvasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment). Evacuatory disorders and pelvic floor dysfunction, like rectoceles, enteroceles, rectoanal intussusception, pelvic floor dyssynergy can be diagnosed using this technique. It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature, with images obtained at rest, straining and sustained squeezing. This technique is an accurate examination for detecting, classifying and following of perianal inflammatory disease. It can also be used to sonographically guide drainage of deep pelvic abscesses, mainly in patients who cannot undergo conventional drainage. Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence, postpartum and also following surgical repair of obstetric tears. There are also some studies referring to its role in anal stenosis, for the measurement of the anal cushions in haemorrhoids and in chronic anal pain. structures interaction during defecation stimulation manoeuvres, as well as the identification, classification, and follow-up in inflammatory perianal disease, and it can also identify sphincter injury in fecal incontinence. In this review the technique is described and the current evidence that supports its use in several areas is also discussed.Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology.

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

“…The perineum is delineated by the pubic symphysis and inferior pubic ligament (ventrally), the coccygeum and anococcygeal ligament (dorsally), the ischium (ventral lateral) and the sacrotuberous ligament (dorsal lateral). It is divided into anterior, central and posterior compartments 93 .…”

Advances in the evaluation of anorectal function

“…Endoanal ultrasonography is widely available and should be considered the cornerstone for anal imaging 102 . The IAS can be classified as normal or pathological, with the latter defined by several factors: sphincter discontinuity (defect) 103 (Figure 3b), atrophy (identified by diffuse thinning of the sphincter [thickness ≤1 mm] 50 ) (Figure 3c) and/or degeneration 104 or hypertrophy 48, 105 .…”

“…Total pelvic ultrasonography has the additional ability to enable classification of organ prolapse, structural and functional causes contributing to evacuation disorders 114 and the identification of pubovisceral avulsion (abnormal insertion of the levator ani on the inferior pubic ramus), which is an important pathophysiological mechanism for pelvic organ prolapse and fecal incontinence 95, 102 . Though not widely available, studies have also used a 4D approach to evaluate dynamic pelvic floor movement in real time 115 .…”

Transperineal Sonography of Anal Mass Status Post Total Colectomy: A Case Report

“…Transperineal sonography is a diagnostic imaging tool used to evaluate the pelvic floor and lower pelvis. 1,2 This approach allows visualization of the urethra, vagina, anorectum, lower uterus, and base of the bladder without insertion of a vaginal or rectal transducer. Indications for transperineal sonography include perineal pain, perineal trauma, vaginal or anorectal obstruction, lower pelvic tumors, abnormal urination or defecation, and pelvic floor dysfunction.…”

“…Indications for transperineal sonography include perineal pain, perineal trauma, vaginal or anorectal obstruction, lower pelvic tumors, abnormal urination or defecation, and pelvic floor dysfunction. 1 This sonographic approach is also useful for image-guided lower pelvic procedures, evaluation of perianal disease in patients with Crohn’s disease, assessment of anal sphincter integrity, and assessment of cervical length and fetal head position during pregnancy. 1,3–6 Adequate visualization of the muscles of the male pelvic floor with transperineal sonography has been reported.…”