Surgeon-Performed Ultrasound in Proctologic Practice

Abstract

Since the introduction of endoanal and endorectal ultrasound by Law and Bartram in 1989, (Law and Bartram 1989) there has been an accelerated use of this technique for the preoperative assessment and management of rectal and anal cancers, (Beynon et al. 1991; Garcia-Aguilar et al. 2002) delineation of the anatomy of complex cryptogenic and inflammatory bowel disease-related perirectal sepsis (Zbar and Armitage 2006; Regadas and Regadas 2008) and for the definition of potentially reparable or augmentable external and internal sphincter defects (Martinez Hernandez Magro et al. 2003; Gravanta and Giordano 2008). Modifications of this technique with hydrogen peroxide enhancement for assessment of fistula-in-ano, (Cheong et al. 1993) Duplex supplementation for detection of perirectal blood flow, (Mallouhi et al. 2004) contrast enhancement (Chew et al. 2003), and 3-dimensional reconstruction with stacked, close interval interpolation (Zimmerman 2003; West et al. 2003; Buchanan et al. 2004) have been recent developments as has been endorectal-guided biopsy of locally recurrent rectal and anal cancers and for perirectal lymph node biopsy particularly following radiotherapy (Gavioli et al. 2000; Liersch et al. 2003). Coronal reconstruction has attempted to resolve some of the limitations inherent in endoanal sonography to provide a multiplanar interpretation of complex fistulous disease and its relationship to the main sphincter complex (Gold et al. 1999; Williams et al. 2001) and has offered useful information about staging of anal cancers prior to definitive chemoradiation (Christensen et al. 2004).