title: Endoanal sonography in assessment of fecal incontinence following obstetric trauma.
abstract: OBJECTIVE
  Fecal incontinence is a common, incapacitating and largely unrecognized medical problem and can be caused by various factors. Obstetric trauma is the most common cause of fecal incontinence secondary to trauma. We aimed to analyze the role of endoanal ultrasound in assessment of this type of fecal incontinence, and report the functional results of surgical treatment.
  
  
  METHODS
  We reviewed the records of all 22 patients with fecal incontinence secondary to obstetric trauma who were evaluated by endoanal ultrasound and underwent surgical management in our department from April to 1997 to April 2002. Pre- and postoperative evaluation of the degree of incontinence was done using the incontinence score of Jorge and Wexner.
  
  
  RESULTS
  The patients had a median age of 43 (range, 29-68) years. All had vaginal deliveries, five of which (22.7%) were instrumental. Most of the patients had total fecal incontinence (solids) with preoperative incontinence score values of 15-20 (median, 18). Endoanal ultrasound confirmed structural defects in the anterior external anal sphincter alone in 16 (72.7%) patients, and both anterior external and internal sphincter defects in six (27.3%) patients. A thinned perineal body was present in all patients. All patients received surgical treatment with overlapping sphincteroplasty and there was improvement of continence in 19 (86.4%) patients with postoperative incontinence score values between 4 and 0 (median, 2).
  
  
  CONCLUSIONS
  Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome.
authors.affiliation: Colorectal Surgery Department, Hospital De Especialidades, Centro Médico Nacional, SXXI, IMSS, México City, Mexico. paulinomhm@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Martínez Hernández Magro
authors.forename: E
authors.initials: E
authors.lastname: Villanueva Sáenz
authors.forename: M
authors.initials: M
authors.lastname: Jaime Zavala
authors.forename: R D
authors.initials: RD
authors.lastname: Sandoval Munro
authors.forename: J L
authors.initials: JL
authors.lastname: Rocha Ramírez
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome