Transperineal sonography of the anal sphincter complex in neonates and infants: differentiation of anteriorly displaced anus from low-type imperforate anus with perineal fistula.
OBJECTIVE
To evaluate the usefulness of transperineal sonography of the anal sphincter complex for differentiating between an anteriorly displaced anus, which is a normal anatomical variant, and a low-type imperforate anus with perineal fistula, which is a pathological developmental abnormality requiring surgical repair.


METHODS
Transperineal sonography was performed with a 13-MHz linear-array transducer on 8 infants (1 day-5.3 months old) who were considered on clinical grounds to have an anteriorly displaced anus and on 9 infants (0-8 months old) with a low-type imperforate anus and perineal fistula confirmed at surgery. The anal sphincter complex was identified and the relationship between the anal canal and the anal sphincter complex was evaluated.


RESULTS
Transperineal sonography was feasible for all children without any specific preparation. An anal canal running within an intact sphincter complex was identified in all infants with an anteriorly displaced anus (n = 8). In 8 of 9 infants with a low-type imperforate anus, a perineal fistula running outside the anal sphincter complex was correctly diagnosed by transperineal sonography. In one infant with a low-type imperforate anus, transperineal sonography revealed a deficient anal sphincter complex.


CONCLUSIONS
Transperineal sonography appears to be a useful non-invasive imaging technique for assessing congenital anorectal abnormalities in neonates and infants, allowing the surgeon to select infants who would benefit from surgical repair.
Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen. peter.haber@med.uni-tuebingen.de
H P
HP
Haber
S W
SW
Warmann
J
J
Fuchs
D001003:Anal Canal / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery; D001006:Anus, Imperforate / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D019160:Endosonography / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010502:Perineum / Q000000981:diagnostic imaging* / Q000601:surgery; D012003:Rectal Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D012016:Reference Values; D012680:Sensitivity and Specificity; D014159:Transducers