Role of manometry, defecography and anal endosonography in the evaluation of colorectal disorders.
OBJECTIVE
altered motility or anatomy of the rectum, anus and perineal floor may lead to symptoms which are unresponsive to routine therapeutic approaches. These disturbances usually lead to constipation, fecal incontinence, or both. Different tests and techniques for evaluating anorectal and perineal disorders, developed in the last two decades, make a better understanding of these disorders possible. This study was designed to evaluate the diagnostic benefits of combining manometry, defecography and anal endosonography in the assessment of patients with anorectal disorders.


METHODS
twenty-five children with constipation (with or without soiling), incontinence and/or prolapse underwent anal manometry, defecography and anal endosonography. Group A consisted of 9 children with fecal incontinence, group B consisted of 10 children with constipation with soiling, and group C comprised 6 children with constipation without soiling.


RESULTS
in group A resting incontinence was associated with a hypotonic external sphincter in 4 out of 9 patients, 2 of whom had internal anal sphincter thinning. In group B resting incontinence was associated with a hypotonic external sphincter in 8 out of 10 patients, 6 of whom had internal anal sphincter thinning. In group C these associations were not seen in any of the patients.


CONCLUSIONS
barium enema is not sufficient for an accurate diagnosis of anorectal disorders. No single test is capable of revealing the type of disease. Anal manometry, defecography and endosonography are complementary procedures in the assessment of this group of disorders. This new approach will improve our knowledge of the pathogenesis of these disorders in children. However, further studies are needed to obtain conclusive evidence.
Varea Calderón
V
V
Sección de Gastroenterología, Hospital "Sant Joan de Déu", Esplugues, Barcelona, 08950, España.
Delgado Carbajal
L
L
Camacho Díaz
E
E
Estringana Pérez
M
M
Alert Casas
E
E
D000293:Adolescent; D001003:Anal Canal / Q000000981:diagnostic imaging*; D001004:Anus Diseases / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis; D019841:Defecography; D004688:Encopresis / Q000175:diagnosis; D019160:Endosonography; D005242:Fecal Incontinence / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D012002:Rectal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging