title: Ultrasonographic assessment of patients referred with chronic anal pain to a tertiary referral centre.
abstract: BACKGROUND
  Chronic anal pain is relatively common as a presentation to specialist physicians and surgeons. Currently, it is regarded as a functional disorder upon the exclusion of occult intersphincteric sepsis. Our study assessed an unselected cohort of patients presenting with chronic previously undiagnosed anal pain using routine ultrasonography.
  
  
  METHODS
  All patients referred to a tertiary gastroenterology service between January 2005 and January 2008 with a diagnosis of chronic anal pain (>3 months duration with no clinical anorectal signs) underwent endoanal and static and dynamic transperineal ultrasound to assess for the frequency and pattern of occult intersphincteric sepsis.
  
  
  RESULTS
  Of 1,580 patients referred, there were 146 presenting with chronic anal pain as a main symptom. Of these, 37 (25.3%) had intersphincteric sepsis (ISS) diagnosed with ultrasound examination with 17 undergoing evaluable surgery. There was a male preponderance (70.3%) with the diagnosis being made in 46% of cases after 6 months of symptoms and with 80.8% having posteriorly located sepsis. This occurred on a background of 62% having previous acute proctological conditions. There was complete ultrasonographic and operative concordance with 15 becoming asymptomatic after surgery at a mean follow-up of 6 months.
  
  
  CONCLUSIONS
  Occult intersphincteric sepsis is not uncommon and is diagnosed using routine ultrasonography at the time of clinical presentation. Endoanal and transperineal ultrasound is recommended as part of the investigative armamentarium to exclude categorization as functional anorectal pain. This is currently not part of the Rome III coding for such a diagnosis suggesting a revision of these diagnostic criteria for the ultimate diagnosis of functional proctalgia.
authors.affiliation: Department of Gastroenterology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Beer-Gabel
authors.forename: D
authors.initials: D
authors.lastname: Carter
authors.forename: M
authors.initials: M
authors.lastname: Venturero
authors.forename: O
authors.initials: O
authors.lastname: Zmora
authors.forename: A P
authors.initials: AP
authors.lastname: Zbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D002908:Chronic Disease; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging* / Q000209:etiology*; D018710:Pain Clinics; D011237:Predictive Value of Tests; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D012017:Referral and Consultation; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult