= Abstract =
Anal Endosonographic Features of the Normal Anus in Children
Sang-Hyun Baek, M.D., Kyung-Nam Park, M.D., Jin-Su Park, M.D., Sao-Young Yoo, M.D.
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
Anal endosonography has recently been popularized in adult patients in order to access staging of rectal cancer and other lesions of the anorectum. This study is not familiar to pediatric surgeons. We performed anal endosonography in 30 children without anorectal disease in order to determine the standard morpholo- gy of the anorectum. The internal anal sphincter(IAS) was clearly identified as
a homogeneous hypoechoic circular band, extending caudally to a level just prox- imal to the anal verge. The external anal sphincter(EAS) showed mixed echogenicity and different architecture along the anal canal; the EAS was U-shape in the upper canal and it had a circular pattern in the lower canal. In the upper canal of girls, the perineal body and the vagina were found just ante- rior of the anal canal, which made the U s hape of the EAS . In the male , the sphincter tapered anteriorly into two arcs that met in the midline. The perineal body was prominent in the female. Poster iorly , the anococcygeal ligament was represented by a triangular shadow in both sex. The thickness of the lAS was measured in 3 directions , left, right and posterior , at 3 levels, upper, middle and lower areas of the anal canal. The average thickness was 0.86 - 2.40 mm between 6 and 18 months of age(Group 1 ), 0.88-3.20 mm between 19 and 36(Group 2),
1.07-2.20 mm between 37 and 54(Group 3) and 1.18-2.42 mm more than 54- month-old(Group 4). The thickness was correlated wtih the age of the children only in the right upper(p = 0.008) and the left middle portion(p=0.015). We were able to obtain standard morphologic features of the normal anal canal in chil- dren with anal endosonography . We believe that this technique is a safe and an effective procedure to evaluate anorectal lesions in children.
Index Words: Anal endosonography, Children
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Fig. 1. The upper anal canal of 54-month-old boy:
The internal sphincter(lAS) is shown as a hypoe- choic ring(xx) and sorrounded by the U-shaped external sphincter(EAS) with mixed echo-genecity.
Anteriorly the EAS is not clearly identified. The perineal body(PB) seen in anterior to the lAS shows hypoechogenecity with hyperechoic center.
The hypoechoic triangular-shaped anococcygeal ligment( AC) is seen posteriorly. A; anterior, P;
posterior, R; right, L; left.
Fig. 2. The middle canal of I3-month-old boy:
The perineal body shows two lateral hypoechoic bands(arrows) and thickening of the lAS is seen in anterior part. The EAS shows more circular pattern than in upper canal.
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ii}Fig. 3. The lower canal of I3-month-old boy: The EAS is completely circular with no visible attach- ments. The intersphincteric wne is not clearly de- fined in children.
Fig. 4_ The upper canal of 22-month-old girl : The perineal body(PB) has broad base and the vagina (V) is seen in anterior of the perineal body.
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Fig. 5. The middle canal of 34-month-old girl:
The perineal body is more prominent in the mid- dle canal of a girl.
Fig. 6. The lower canal of 71-month-old girl : The EAS shows circular pattern; however, the perine- al body and the anococcygeal ligament are still seen in this level.
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Age (months)
Fig. 7. The thickness of the lAS according to the age in the upper anal canal. The lines show corre- lation between the thickness and the age(Spear- man's rank correlation method). The correlation is significant only in the right side(* p=O.00816)
Thickness (mOl)
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Fig. 8. The thickness of the lAS according to the age in the . middle anal canal The correlation is significant in the left side(* p=O.01591)
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Table 1. Thickness of the Internal Anal Sphincter ,
Group Age(month)
1 6~18
2 19~36
3 37~54
4 55(
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0.05),No. of Pts. Thickness(mm)
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