title: Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries.
abstract: OBJECTIVE
  Fecal incontinence and constipation are common problems in follow-up of anorectal malformations (ARMs). We evaluated the anal sphincters using the 3-dimensional endoanal ultrasonography (3D-EAUS) and the anorectal manometry after ARMs repair.
  
  
  METHODS
  Seventeen patients, divided into 3 groups according to Wingspread classification, underwent anorectal manometry and 3D-EAUS. Clinical, manometric, and endosonographic scoring systems were used.
  
  
  RESULTS
  The average anal resting pressure (aARP) was significantly higher in low ARMs than in intermediate and high ARMs. The anal squeeze pressure was not statistically different between the 3 groups. Three-dimensional EAUS visualized internal anal sphincter (IAS) disruptions in 7 of 17 patients and absence of IAS in 6 of 17 children with high ARMs. Scars of the external anal sphincter were localized in low ARMs and generalized in the other groups. In the case of IAS disruption with aARP greater than 20 mm Hg, fecal incontinence and constipation improved with biofeedback and/or laxatives, whereas daily enemas were necessary in absence of IAS with aARP less than 20 mm Hg. Statistical correlation was observed between endosonographic and manometric findings and clinical outcomes.
  
  
  CONCLUSIONS
  Lesions of the anal sphincter are common in ARMs. Three-dimensional EAUS and anorectal manometry ensure a complete assessment of the anal sphincter and could provide useful information to define the most appropriate treatments to improve the quality of life.
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy. tamara.caldaro@opbg.net
authors.forename: Tamara
authors.initials: T
authors.lastname: Caldaro
authors.forename: Erminia
authors.initials: E
authors.lastname: Romeo
authors.forename: Paola
authors.initials: P
authors.lastname: De Angelis
authors.forename: Rosa Alba
authors.initials: RA
authors.lastname: Gambitta
authors.forename: Francesca
authors.initials: F
authors.lastname: Rea
authors.forename: Filippo
authors.initials: F
authors.lastname: Torroni
authors.forename: Francesca
authors.initials: F
authors.lastname: Foschia
authors.forename: Giovanni Federici
authors.initials: GF
authors.lastname: di Abriola
authors.forename: Luigi
authors.initials: L
authors.lastname: Dall'Oglio
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000503:physiopathology / Q000601:surgery*; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D019160:Endosonography; D004733:Enema; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome