Abstract
Twenty-one patients with histologically proven solitary rectal ulcer syndrome (SRUS) were examined by anal endosonography (AES) in order to determine the frequency of any ultrasound abnormality. Comparison was made with a group of 17 age and sex matched asymptomatic subjects. Four patients with SRUS had anal sphincter defects on AES. All were of the internal anal sphincter (IAS), which appeared fragmented in two patients with complete rectal prolapse. Measurements of internal and external anal sphincter (EAS) diameter and cross-sectional crea were taken, excluding the 4 patients with defects. The submucosa was inhomogeneous (P=0.0016) and thickness increased in patients with SRUS (median 4.0 mm vs 2.0 mm; P<0.0001). IAS diameter was increased (median 3.8 mm vs 2.0 mm; P<0.0001), as was cross-sectional area (median 241 sq mm vs 112 sq mm; P<0.0001). EAS diameter was also increased (median 8.5 mm vs 7.0 mm; P=0.0173), as was cross-sectional area (median 905 sq mm vs 594 sq mm; P=0.0052). The ratio of EAS to IAS thickness was reduced in patients with SRUS (median 2.6 vs 4.0; P=0.0029). The mechanism of these changes is unclear but apparent muscle hypertrophy on ultrasound may diagnose those patients with SRUS in whom defecatory difficulty is a predominant symptom.
Résumé
Vingt-et-un patients présentant un ulcère solitaire du rectum prouvé histologiquement (SRUS) ont été examinés par échographie endo-anale (AES) afin de déterminer la fréquence d'anomalies échographiques. Une comparison a été établie avec un groupe de 17 sujets asymptomatiques comparatifs quant à l'âge et au sexe. Quatre patients avec un SRUS présentaient des défects sphinctériens à l'échographie. Toutes les anomalies poraient sur le sphincter interne qui apparaissait comme fragmenté chez deux patients porteurs d'un prolapsus complet du rectum. Des mesures du diamètre et de la surface de section des sphincters internes et externes ont été établies à l'exclusion des 4 patients-présentant des défauts sphinctériens. La sous-muqueuseétait inhomogène (P=0.007) et le sphincter était épaissi chez des patients porteurs d'un ulcère solitaire (médiane 4,0 mm versus 2,0 mm; P<0.0001). Le diamètre du sphincter interne était augmenté (médiane 3,8 mm versus 2,0 mm; P<0.0001), de même que la surface de section (médiane 241 mm2 versus 112 mm2, P<0,0001). Le diamètre du sphincter externe était également augmenté (8,5 mm versus 7,0 mm; P=0.0173), de même que la surface de la section (mediane 905 mm2 versus 504 mm2; P=0.0052). Le ratio de l'épaisseur du sphincter externe par rapport à l'épaisseur du sphincter interne était réduit chez les patients porteurs d'un ulcère solitaire du rectum (médiane 2,6 versus 4,0; P=0.0029). Le canisme de ces changements n'est pas clair mais l'hypertrophie apparente du muscle lors de l'examen échographique permet d'identifier les patients porteurs d'un ulcère solitaire du rectum chez lesquels des problèmes d'exonération constitutent un symptôme prédominant.
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Halligan, S., Sultan, A., Rottenberg, G. et al. Endosonography of the anal sphincters in solitary rectal ulcer syndrome. Int J Colorect Dis 10, 79–82 (1995). https://doi.org/10.1007/BF00341201
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DOI: https://doi.org/10.1007/BF00341201