title: Transperineal sonographic anal sphincter complex evaluation in chronic anal fissures.
abstract: OBJECTIVE
  The purpose of this study was to assess the role of transperineal sonography in assessment of pathologic changes to the anal sphincter complex in patients with chronic anal fissures.
  
  
  METHODS
  We conducted a prospective case-control study of 100 consecutive patients of any age and both sexes with chronic anal fissures who presented to a colorectal clinic between January 2012 and August 2013 (group A) and 50 healthy volunteers (group B).
  
  
  RESULTS
  The most common patterns of radiologic changes to anal sphincters associated with chronic anal fissures were circumferential thickening of the anal sphincter complex in 5 patients (5%), circumferential thickening of the internal anal sphincter in 3 patients (3%), preferential thickening of the internal anal sphincter at the 6-o'clock position in 80 patients (80%) and the 12-o'clock position in 7 patients (7%), preferential thickening of the internal and external anal sphincters in 3 patients (3%), and thinning of the internal anal sphincter in 2 patients (2%).
  
  
  CONCLUSIONS
  Chronic anal fissures cause differential thickening of both internal and external anal sphincters, with a trend toward increased thickness in relation to the site of the fissure. Routine preoperative transperineal sonography for patients with chronic anal fissures is recommended, and it is mandatory in high-risk patients.
authors.affiliation: Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.).
authors.forename: Elsaid M
authors.initials: EM
authors.lastname: Bedair
authors.affiliation: Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.). hennawyhany@hotmail.com.
authors.forename: Hany M
authors.initials: HM
authors.lastname: El Hennawy
authors.affiliation: Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.).
authors.forename: Ahmed Abdu
authors.initials: AA
authors.lastname: Moustafa
authors.affiliation: Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.).
authors.forename: Gad Youssef
authors.initials: GY
authors.lastname: Meki
authors.affiliation: Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.).
authors.forename: Bosat Elwany
authors.initials: BE
authors.lastname: Bosat
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult
keywords: chronic anal fissure; gastrointestinal ultrasound; sphincterotomy; transperineal sonography