Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries

Journal of Pediatric Surgery, 06/01/2012

Lesions of the anal sphincter are common in ARMs. Three–dimensional EAUS and anorectal manometry ensure a complete assessment of the anal sphincter and could provide useful information to define the most appropriate treatments to improve the quality of life.


  • Seventeen patients, divided into 3 groups according to Wingspread classification, underwent anorectal manometry and 3D–EAUS. Clinical, manometric, and endosonographic scoring systems were used.


  • The average anal resting pressure (aARP) was significantly higher in low ARMs than in intermediate and high ARMs.
  • The anal squeeze pressure was not statistically different between the 3 groups.
  • Three–dimensional EAUS visualized internal anal sphincter (IAS) disruptions in 7 of 17 patients and absence of IAS in 6 of 17 children with high ARMs.
  • Scars of the external anal sphincter were localized in low ARMs and generalized in the other groups.
  • In the case of IAS disruption with aARP greater than 20 mm Hg, fecal incontinence and constipation improved with biofeedback and/or laxatives, whereas daily enemas were necessary in absence of IAS with aARP less than 20 mm Hg.
  • Statistical correlation was observed between endosonographic and manometric findings and clinical outcomes.

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