Thickening of the internal anal sphincter in idiopathic constipation in children

Keshtgar, Alireza S.; Ward, Harry C.; Clayden, Graham; Sanei, Ahmad

doi:10.1007/s00383-004-1233-4

Cited by 45 publications

(46 citation statements)

References 31 publications

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“…The ARM was done by a method based on a balloon system under ketamine anaesthesia and patient was lying in left lateral position as described previously [8]. We used the anorectal manometry analyser software, AMA version 3.11, developed by author (Keshtgar) [23].…”

Section: Methodsmentioning

confidence: 99%

“…ES is easily performed and is of great value for recording sphincter defects in patients with anal fistulas and abscesses, muscular dystrophy, idiopathic faecal incontinence and ARA [8,[13][14][15]. The ES is a validated technique that can be applied with confidence to children with repaired ARA.…”

Section: Introductionmentioning

confidence: 99%

“…Anal endosonography (ES) has been used to assess the anatomy of the pelvic floor and anal sphincters and it has been validated by electromyography, anorectal manometry and histological examination of the sphincters [3,5,[8][9][10][11][12]. ES is easily performed and is of great value for recording sphincter defects in patients with anal fistulas and abscesses, muscular dystrophy, idiopathic faecal incontinence and ARA [8,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

et al. 2008

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The aim of this study was to evaluate role of anorectal manometry (ARM) and anal endosonography (ES) in assessment of the internal anal sphincter (IAS) quality on continence outcome following repair of anorectal anomalies (ARA). We devised a scoring system to evaluate the quality of the IAS based on ARM and ES and correlated the scores with clinical outcome, using a modified Wingfield score (MWS) for faecal continence. We also assessed the implication of megarectum and neuropathy on faecal continence. Of 54 children studied, 34 had high ARA and 20 had low ARA. Children with high ARA had poor sphincters on ES and ARM, and also poor faecal continence compared to those with low ARA. The presence of megarectum and neuropathy was associated with uniformly poor outcome irrespective of the IAS quality. The correlations between MWS on one hand, and ES and ARM scores for IAS on the other hand were weak in the whole study group, ES r = 0.27, P < 0.04, and ARM r = 0.39, P < 0.004. However, the correlations were strong in those who had isolated ARA without megarectum or neuropathy, ES r = 0.51, P < 0.02 and ARM r = 0.55, P < 0.01, respectively. In conclusion, the ARM and ES are valuable in evaluation of continence outcome in children after surgery for ARA and those with good quality IAS had better faecal continence. The IAS is a vital component in functional outcome in absence of neuropathy and megarectum.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

et al. 2008

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“…It is an infrequent entity but medical or surgical treatment improves most cases. A hypertrophied anal sphincter has also been described in children with chronic constipation (29). In a study published by Christiansen et al (5) ultrasound studies were performed on 18 patients, 13 women and 5 men with chronic anal pain, and showed that in 12 cases some ultrasound abnormalities were present.…”

Section: Discussionmentioning

confidence: 99%

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

García-Montes

Argüelles-Arias

Jiménez-Contreras

et al. 2010

Rev. esp. enferm. dig.

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Objective: to assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP).Material and method: this is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months' duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used.Results: one patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman).Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

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“…However, methods need to be standardized and more studies are needed before recommending routine use of ultrasonography in assessing children with constipation. Using endosonography techniques, Keshtgar et al have shown that children with chronic constipation have a thickened external anal sphincter complex 68 . The clinical utility value of this finding is yet to be determined.…”

Section: Investigationsmentioning

confidence: 99%

Constipation in children: From misty to understanding

Rajindrajith

2014

Sri Lanka J Child Health

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Thickening of the internal anal sphincter in idiopathic constipation in children

Cited by 45 publications

References 31 publications

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

Constipation in children: From misty to understanding

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