Results of Anal Endosonography

An image of the EAS was obtained in all ten patients with high anomalies; however, the distribution of the image was inadequate. The hyperechoic layer corresponding to the EAS was not completely defined from the surrounding tissues, although it was moderately defined in all ten patients (Fig. 26.6). The continuity of the hyperechoic layer was partially interrupted in two patients, and was complete in eight. The IAS was seen in five of the ten patients with high anomalies. Four out of the five patients showed a well-defined layer corresponding to the IAS with circular continuity, but the other showed complete interruption of the hypoechoic band.

The EAS was seen in all five patients with intermediate anomalies (Fig. 26.7). In addition, a well-defined layer corresponding to the EAS and uninter rupted continuity of the EAS image were noted in two. A moderately defined layer was observed in the other three patients. The IAS was seen in one patient with an intermediate anomaly, and was not seen in the remaining four patients.

Anal endosonography has demonstrated that patients with high anomalies have less adequate distribution of the EAS compared with those with intermediate anomalies, especially for the hyperechoic layer. These results indicate that patients with high anomalies have a congenitally rudimentary EAS.

The IAS has been regarded as being congenitally absent in patients with high or intermediate anomalies. However, Rintala reported the presence of the IAS even in patients with high anomalies, and stressed the importance of preserving the IAS at the time of surgery [11]. In the present study, five of the ten patients with high-type anomalies and one of the five patients with intermediate-type anomalies showed the hypoechoic band that corresponds to the IAS. Therefore, if the IAS is present in patients with high or intermediate anomalies, its preservation might contribute to the improvement of postoperative ano-rectal function.

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