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Abstract

The anal canal is 2–4 cm long. The dentate line of the mucosa denotes the squamocolumnar junction. The circular smooth muscle of the rectal wall continues downward as the internal anal sphincter (IAS). Anteriorly the muscle fibers from its anterior superior part run into the perineal body. The outer longitudinal component of the muscolaris propria extends as the longitudinal layer of the anal canal. It acts as an anchor, with its fibroelastic component permeating through the subcutaneous part of the external sphincter, terminating in the perianal skin.

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References

  1. Bartram CI, Frudinger A. Handbook of anal endosonography. Petersfield, UK: Wrightson Biomedical Publishing Ltd, 1997

    Google Scholar 

  2. Nielsen MB, Hauge C, Rasmussen OO, Sorensen M, Pederson JF, Christiansen J. Anal sphincter size measured by endosonography in healthy volunteers. Effect of age, sex and parity. Acta Radiol 1992;33:453–456

    PubMed  CAS  Google Scholar 

  3. Burnett SJD, Bartram CI. Endosonographic variations in the normal internal anal sphincter. Int J Colorectal Dis 1991;6:2–4

    Article  PubMed  CAS  Google Scholar 

  4. Enck P, Heyer T, Gantke B, Schmidt WU, Schafer R, Frieling T, Haussinger D. How reproducible are measures of the anal sphincter muscle diameter by endoanal ultrasound? AJG 1997;92:293–296

    PubMed  CAS  Google Scholar 

  5. Zetterstrom JP, Mellgren A, Jensen LL, Wong WD, Kim DG, Lowry AC, Madoff RD, Congilosi SM. Effect of delivery on anal sphincter morphology and function. Dis Colon Rectum 1999;42:1253–1260

    Article  PubMed  CAS  Google Scholar 

  6. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905–1911

    Article  PubMed  CAS  Google Scholar 

  7. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg 2000;24:208–215

    Article  PubMed  CAS  Google Scholar 

  8. Hussain SM, Stoker J, Schutte HE, Lameris JS. Imaging of the anorectal region. Europ J Radiol 1996; 22:116–122

    Article  CAS  Google Scholar 

  9. Tjandra JJ, Milsom JW, Stolfi VM, Lavery I, Oakley J, Church J, Fazio V. Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor. Dis Colon Rectum 1992,35:465–470

    Article  PubMed  CAS  Google Scholar 

  10. Zetterstrom JP, Mellgren A, Madoff RD, Kim DG, Wong WD. Perineal body measurement improves evaluation of anterior sphincter lesions during endoanal ultrasonography. Dis Colon Rectum 1998;41:705–713

    Article  PubMed  CAS  Google Scholar 

  11. Williams AB, Bartram CI, Halligan S, Marshall MM, Nicholls RJ, Kmiot WA. Multiplanar anal endosonography-normal anal canal anatomy. Colorectal Dis 2001;3:169–174

    Article  PubMed  CAS  Google Scholar 

  12. Bartram CI, Frudinger A. Handbook of anal endosonography. Petersfield, UK: Wrightson Biomedical Publishing Ltd, 1997

    Google Scholar 

  13. Hildebrandt U, Feifel G, Schwarz HP, Scherr O. Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis 1986;1:203–207

    Article  PubMed  CAS  Google Scholar 

  14. Kumar A, Scholefleld JH. Endosonography of the anal canal and rectum. World J Surg 2000; 24:208–215

    Article  PubMed  CAS  Google Scholar 

  15. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–46

    Article  PubMed  CAS  Google Scholar 

  16. Hussain SM, Stoker J, Schutte HE, Lameris JS. Imaging of the anorectal region. Europ J Radiol 1996;22:116–122

    Article  CAS  Google Scholar 

  17. Hunerbein M, Schlag PM. 3D-endosonography for staging of rectal cancer. Ann Surg 1997;225:432–438

    Article  PubMed  CAS  Google Scholar 

  18. Gold DM, Halligan S, Kmiot WA, Bartram CI. Intraobserver and interobserver agreement in anal endosonography. Br J Surg 1999;86:371–375

    Article  PubMed  CAS  Google Scholar 

  19. Enck P, Heyer T, Gantke B, Schmidt WU, Schafer R, Frieling T, Haussinger D. How reproducible are measures of the anal sphincter muscle diameter by endoanal ultrasound? Am J Gastroenterol 1997;92: 293–296

    PubMed  CAS  Google Scholar 

  20. Dalley AF. The riddle of the sphincters. The morphophysiology of the anorectal mechanism reviewed. Am Surg 1987;53:298–306

    PubMed  Google Scholar 

  21. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–1911

    Article  PubMed  CAS  Google Scholar 

  22. Hussain SM, Stoker J, Lameris JS. Anal sphincter complex: endoanal MR imaging of normal anatomy. Radiology 1995;197:671–677

    PubMed  CAS  Google Scholar 

  23. Schafer A, Enck P, Furst G, Kahn T, Frieling T, Lubke HJ. Anatomy of the anal sphincters. Comparison of anal endosonography to magnetic resonance imaging. Dis Colon Rectum 1994;37:777–781

    Article  PubMed  CAS  Google Scholar 

  24. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 1994;81:463–465

    Article  PubMed  CAS  Google Scholar 

  25. Vaizey CJ, Kamm MA, Bartram CI. Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence. Lancet 1997;349:612–615

    Article  PubMed  CAS  Google Scholar 

  26. Frudinger A, Halligan S, Bartram CI, Price AB, Kamm MA, Winter R. Female anal sphincter: age-related differences in asymptomatic volunteers with high-frequency endoanal US. Radiology 2002;224:417–423

    Article  PubMed  Google Scholar 

  27. Burnett SJ, Spence-Jones C, Speakman CT, Kamm MA, Hudson CN, Bartram CI. Unsuspected sphincter damage following childbirth revealed by anal endosonography. Br I Radiol 1991;64:225–227

    Article  CAS  Google Scholar 

  28. Nielsen MB, Rasmussen OO, Pedersen JF, Christiansen J. Anal endosonographic findings in patients with obstructed defecation. Acta Radiol 1993;34:35–38

    PubMed  CAS  Google Scholar 

  29. Tarantino D, Bernstein MA. Endoanal ultrasound in the staging and management of squamous-cell carcinoma of the anal canal: potential implications of a new ultrasound staging system. Dis Colon Rectum 2002 Jan;45:16–22

    Article  PubMed  Google Scholar 

  30. Boman BM, Moertel CG, O’Connell MJ, Scott M, Weiland LH, Beart RW, Gunderson LL, Spencer RJ. Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 1984;54:114–125

    Article  PubMed  CAS  Google Scholar 

  31. Goldman S, Norming U, Svensson C, Glimelius B. Transanorectal ultrasonography in the staging of anal epidermoid carcinoma. Int J Colorect Dis 1991;6:152–157

    Article  CAS  Google Scholar 

  32. DeSouza NM, Puni R, Zbar A, Gilderdale DJ, Coutts GA, Krausz T. MR imaging of the anal sphincter in multiparous women using an enoanal coil: correlation with in-vitro anatomy and appearances in fecal incontinence. AJR Am J Roentgenol 1996;167:1465–1471

    PubMed  CAS  Google Scholar 

  33. Briel JW, Stocker J, Rociu E, Lameris JS, Hop WC, Schouten WR. External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg 1999;86:1322–1327

    Article  PubMed  CAS  Google Scholar 

  34. Williams AB, Bartram CI, Modhwadia D, et. Al. Endocoil magnetic resonance imaging quantification of external sphincter atrophy. Br J Surg 2001;88: 853–859

    Article  PubMed  CAS  Google Scholar 

  35. Williams AB, Malouf AJ, Bartram CI, Halligan S, Kamm MA, Kmiot WA. Assessment of external anal sphincter morphology in idiopathic fecal incontinence with endocoil magnetic resonance imaging. Dig Dis Sci 2001;46:1466–1471

    Article  PubMed  CAS  Google Scholar 

  36. Fritsch H, Brenner E, Lienemann A, Ludwikowski B. Anal sphincter complex: reinterpreted morphology and its clinical relevance. Dis Colon Rectum 2002; 45:188–194

    Article  PubMed  Google Scholar 

  37. Bollard RC, Gardiner A, Lindow S, Phillips K, Duthie GS. Nor male female anal sphincter: difficulties in interpretation explained. Dis Colon Rectum 2002;45:171–175

    Article  PubMed  CAS  Google Scholar 

  38. Hussain SM, Stoker J, Zwamborn AW, et al. Endoanal MR imaging of the anal sphincter complex: correlation with cross-sectional anatomy and histology. J Anat 1996;189:677–682

    PubMed  Google Scholar 

  39. Rociu E, Stoker J, Eijkemans MJC, Lameris JS. Normal anal sphincter anatomy and age-and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology 2000;217:395–401

    PubMed  CAS  Google Scholar 

  40. Morren GL, Beets-Tan GH, van Engelshoven MA. Anatomy of the anal canal and perianal structures as defined by phase-array magnetic resonance imaging. Br J Surg 2001;88:1506–1512

    Article  PubMed  CAS  Google Scholar 

  41. Maier A, Fuchsjager M. Preoperative staging of rectal cancer. Eur J Radiol 2003;47:89–97

    Article  PubMed  Google Scholar 

  42. Akasu T, Sugihara K, Moriya Y, Fujita S. Limitations and pitfalls of transrectal ultrasonography for staging of rectal cancer. Dis Colon Rectum 1997;40(Suppl.) S10–S15

    Article  PubMed  CAS  Google Scholar 

  43. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg 2000;24:208–215

    Article  PubMed  CAS  Google Scholar 

  44. Napolean B, Pujol B, Berger F, Valette PJ, Gerard JP, Souquet JC. Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy. Br J Surg 1991;78:785

    Article  Google Scholar 

  45. Lohnert MSS, Doniec JM, Henne-Bruns D. Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences. Dis Colon Rectum 2000;43:483–491

    Article  PubMed  CAS  Google Scholar 

  46. Dukes CE. The classification of cancer of the rectum. J Pathol 1932;35:323–332

    Article  Google Scholar 

  47. Astler VB, Coller F. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139:846–851

    Article  PubMed  CAS  Google Scholar 

  48. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–46

    Article  PubMed  CAS  Google Scholar 

  49. Herzog U, von Flue M, Tondelli P, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 1993;36:127–134

    Article  PubMed  CAS  Google Scholar 

  50. Sentovich S, Blatchford G, Falk P, Thorson A, Christensen M. Transrectal ultrasound of rectal tumors. Am J Surg 1993;166:638–641

    Article  PubMed  CAS  Google Scholar 

  51. Anderson BO, Hann LE, Enker WE, Dershaw DD, Guillem JG, Cohen AM. Transrectal ultrasonography and operative selection for early carcinoma of the rectum. J Am Coll Surg 1994;179:513–517

    PubMed  CAS  Google Scholar 

  52. Harnsberger JR, Charvat P, Longo WE, Vernava AM, Salimi Z, Arends T, Daniel G. The role of intrarectal ultrasound in staging of rectal cancer and detection of extrarectal pathology. Am Surg 1994;60:571–576

    PubMed  CAS  Google Scholar 

  53. Glaser F, Schlag P, Herfarth C. Endorectal ultrasonography for the assessment of invasion of rectal tumors and lymph node involvement. Br J Surg 1990;77:883–887

    Article  PubMed  CAS  Google Scholar 

  54. Holdsworth PJ, Johnston D, Chalmers AG, Chennells P, Dixon MF, Finan PJ, Primrose JN, Quirke P. Endoluminal ultrasound and computed tomography in the staging of rectal cancer. Br J Surg 1988;75:1019–1022

    Article  PubMed  CAS  Google Scholar 

  55. Orrom WJ, Wong WD, Rothenberger DA, Jensen LL, Goldberg SM. Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience. Dis Colon Rectum 1990;33:654–659

    Article  PubMed  CAS  Google Scholar 

  56. Hulsmans FJ, Castelijns JA, Reeders JW, Tytgat GN. Review of artifacts associated with transrectal ultrasound: understanding, recognition and prevention of misinterpretation. J Clin Ultrasound 1995;23:483–494

    Article  PubMed  CAS  Google Scholar 

  57. Yamashita Y, Machi J, Shirouzu K, Morotomi T, Isomoto H, Kakegawa T. Evaluation of endorectal ultrasound for the assessment of wall invasion of rectal cancer: report of a case. Dis Colon Rectum 1988;31:362–368

    Article  Google Scholar 

  58. Dershaw DD, Enker WE, Cohen AM, Sigurdson ER. Transrectal ultrasonography of rectal carcinoma. Cancer 1990;66:2336–2340

    Article  PubMed  CAS  Google Scholar 

  59. Beynon J, Mortensen NJ, Foy DM, Channer JL, Virjee J, Goddard P. Preoperative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography Br J Surg 1986;73:1015–1017

    Article  PubMed  CAS  Google Scholar 

  60. Garcia-Aguilar J, Pollack J, Lee S-H, Hernandez de Anda E, Mellgren A, Wong WD, Finne CO, Rothenberger DA, Madoff RD. Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum 2002;45:10–15

    Article  PubMed  Google Scholar 

  61. Akasu T, Sunouchi K, Sawada T, Tsioulias GJ, Muto T, Morioka Y. Preoperative staging of rectal carcinoma: prospective comparison of transrectal ultrasonography and computed tomography. Gastroenterology 1990;98:268

    Google Scholar 

  62. Jochem RJ, Reading CC, Dozois RR, Carpenter HA, Wolff BG, Charboneau JW. Endorectal ultrasonograpic staging of rectal carcinoma. Mayo Clin Proc 1990;65:1571–1577

    Article  PubMed  CAS  Google Scholar 

  63. Sailer M, Leppert R, Bussen D, Fuchs KH, Thiede A. Influence of tumor position on accuracy of endorectal ultrasound staging. Dis Colon Rectum 1997;40:1180–1186

    Article  PubMed  CAS  Google Scholar 

  64. Kim HJ, Wong WD. Role of endorectal ultrasound in the conservative management of rectal cancers. Semin Surg Oncol 2000;19:358–366

    Article  PubMed  CAS  Google Scholar 

  65. Santoro GA, Pastore C, Barban M, Di Falco G. Role of endorectal ultrasound in the management of rectal cancers. Hepato-Gastroenterology 2001;48(SI):CXIX

    Google Scholar 

  66. Kruskal JB, Sentovich SM, Kane RA. Staging of rectal cancer after polypectomy: usefulness of endorectal US. Radiology 1999;211:31–35

    PubMed  CAS  Google Scholar 

  67. Mier AG, Barton PP, Heuhold NR, Herbst F, Teleky BK, Lechner GL. Peritumor tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation. Radiology 1997;203:785–789

    Google Scholar 

  68. Katsura Y, Yamada K, Ishizawa T, Yoshinaka H, Shimazu H. Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum 1992;35:362–368

    Article  PubMed  CAS  Google Scholar 

  69. Boyce GA, Sivak MV, Lavery IC, Fazio VW, Church JM, Milsom J, Petras R. Endoscopic ultrasound in the preoperative staging of rectal carcinoma. Gastrointest Endosc 1992;38:468–471

    Article  PubMed  CAS  Google Scholar 

  70. Senesse P, Khemissa F, Lemanski C, Masson B, Quenet F, Saint-Aubert B, Simony J, Ychou M, Dubois JB, Rouanet P. Contribution of endorectal ultrasonography in preoperative evaluation for very low rectal cancer. Gastroenterol Clin Biol 2001;25:24–28

    PubMed  CAS  Google Scholar 

  71. Romano G, de Rosa P, Vallone G, Rotondo A, Grassi R, Santangelo ML. Intrarectal ultrasound and computed tomography in the pre-and postoperative assessment of patients with rectal cancer. Br J Surg 1985; 72(suppl):s117–s119

    Article  PubMed  Google Scholar 

  72. Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT. Radiology 1989;170:319–322

    PubMed  CAS  Google Scholar 

  73. Wazier A, Zitron S, Ben-Baruch D, Baniel J, Wolloch Y, Dintsman M. Comparative study for preoperative staging of rectal cancer. Dis Colon Rectum 1989;32:53–56

    Article  Google Scholar 

  74. Goldman S, Arvidson H, Normig U, Lagerstedt U, Magnusson I, Frisell J. Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma. Gastrointestinal Radiol 1991;16:259–263

    Article  CAS  Google Scholar 

  75. Waizer A, Powsner E, Russo I, Hadar S, Cytron S, Lombrozo R, Wolloch Y, Antebi E. Prospective comparative study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow-up of rectal cancer: preliminary report. Dis Colon Rectum 1991;34:1068–1072

    Article  PubMed  CAS  Google Scholar 

  76. Thaler W, Watzka S, Martin F, Guardia GL, Psenner K, Bonatti G, Fichtel G, Egarter-Vigl E, Marzoli GP. Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging, preliminary results of a prospective comparative study. Dis Colon Rectum 1994;37:1189–1193

    Article  PubMed  CAS  Google Scholar 

  77. Starck M, Bohe M, Fork FT, Lindstrom C, Sjoberg S. Endoluminal ultrasound and low-field magnetic resonance imaging are superior to clinical examination in the preoperative staging of rectal cancer. Eur J Surg 1995;161:841–845

    PubMed  CAS  Google Scholar 

  78. Joosten FB, Jansen JB, Joosten HJ, Rosenbusch G. Staging of rectal carcinoma using MR double surface coil, MR endorectal coil and intrarectal ultrasound: correlation with histopathologic findings. J Comput Assist Tomogr 1995;19:752–758

    Article  PubMed  CAS  Google Scholar 

  79. Zerhouni EA, Rutter C, Hamilton SR, Balfe DM, Megibow AJ, Francis IR, Moss AA, Heiken JP, Tempany CM, Aisen AM, Weinreb JC, Gatsonis C, McNeil BJ. CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology 1996;200:443–451

    PubMed  CAS  Google Scholar 

  80. Zagoria RJ, Scharlb CA, Ott DJ, Bechtoldt RI, Wolfman NT, Scharling ES, Chen MY, Loggie BW. Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparison with endoscopic rectal sonography. J Surg Oncol 1997;64:312–317

    Article  PubMed  CAS  Google Scholar 

  81. Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 1999;42:770–775

    Article  PubMed  CAS  Google Scholar 

  82. Kim NK, Kim MJ, Park JK, Park SI, Min JS. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol 2000;7:732–737

    Article  PubMed  CAS  Google Scholar 

  83. Civelli EM, Gallino G, Mariani L, Cozzi G, Biganzoli E, Salvetti M, Gallo R, Belli F, Bonfanti G, Bertario L, Andreola S, Leo E. Double-contrast barium enema and computerised tomography in the pre-operative evaluation of rectal carcinoma: are they still useful diagnostic procedures? Tumori 2000;86:389–392

    PubMed  CAS  Google Scholar 

  84. Meyenberger C, Huch Boni RA, Bertschinger P, Zala GF, Klotz HP, Krestin GP. Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer. Endoscopy 1995;27:469–479

    Article  PubMed  CAS  Google Scholar 

  85. Gualdi GF, Casciani E, Gadalaxara A, d’Orta C, Polettini E, Pappalardo G. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histological findings. Dis Colon Rectum 2000;43:338–345

    Article  PubMed  CAS  Google Scholar 

  86. Hunerbein M, Pegios W, Bau R, Vogl TJ, Felix R, Schlag PM. Prospective comparison of endorectal ultrasound, three-dimensional ultrasound and endorectal MRI in the preoperative evaluation of rectal tumors. Preliminary results. Surg Endosc 2000;14:1005–1009

    Article  PubMed  CAS  Google Scholar 

  87. Kim JC, Cho YK, Kim SY, Park SK, Lee MG. Comparative study of three-dimensional and conventional endorectal ultrasonography used in rectal cancer staging. Surg Endosc 2002;16:1280–1285

    Article  PubMed  CAS  Google Scholar 

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Santoro, G.A., Di Falco, G., Ratto, C. (2004). Basic anatomy. In: Atlas of Endoanal and Endorectal Ultrasonography. Springer, Milano. https://doi.org/10.1007/978-88-470-2129-7_3

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