ABSTRACT
Endosonography gives detailed information on the internal and external anal sphincters. The goals of this study were to evaluate findings on anal endosonography in patients with anal incontinence and to study the value of endosonography for selecting the most effective surgical treatment. Forty-eight patients with incontinence for either gas (17 patients) or faeces (31 patients) were studied. Nineteen patients had idiopathic incontinence, 29 were incontinent due to previous obstetrical or surgical trauma. Endosonography and measurement of anal canal pressures were performed in all patients, 40 had needle electromyography. The endosonograms were evaluated without knowledge of the clinical findings and correlated with the results of needle electromyography, with the anal pressures, and to the type of surgery subsequently performed. In 30 patients surgery was subsequently planned on the basis of the results of endosonography and the anophysiologic examinations. Endosonograms showed defects in 27 external sphincters, 12 of whom had internal sphincter defects also. One patient had an abnormal thinning of the external sphincter. Eight patients had defects of the internal sphincter as the only finding. Twenty-two of the patients with sonographically detected defects or thinning of the external sphincter had an EMG performed, this showed defects of the external sphincter in 18, four defects in the middle and upper anal canal had not been found. There was no correlation between the sphincteric defects found by endosonography and the anal canal pressures. Sphincter reconstruction was offered to most patients with damage to the external sphincter; patients with isolated defects in the internal sphincter or intact internal and external sphincters were offered a number of other surgical procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Anal Canal/diagnostic imaging , Fecal Incontinence/diagnostic imaging , Adult , Aged , Anal Canal/physiopathology , Anal Canal/surgery , Evaluation Studies as Topic , Fecal Incontinence/etiology , Fecal Incontinence/surgery , Female , Humans , Male , Middle Aged , Ultrasonography, InterventionalABSTRACT
The complications of pregnancy and delivery in a material consisting of 841 women without obstetric risk factors were investigated. The deliveries were planned to take place in a department of general surgery with a specialist obstetrician. Seventy-five women (8.9%) were transferred to a specialized obstetric department before delivery, 14 women (1.7%) because of imminent premature delivery. In addition, 69 women were transferred because of removal or their own wish for transfer. A total of 631 patients (90.5%) were delivered vaginally and 66 (9.5%) were delivered abdominally. In thirty-five of these, caesarean sections were performed during the course of delivery. In 34 deliveries (5.1%) vacuo extraction was used. Among 181 women (27.1%), unexpected complications occurred, 80 of these women (12.0%) requiring emergency treatment. A total of 697 infants were delivered. One infant died before delivery because of placental separation. Twenty-two infants (3.2%) were transferred to a paediatric department during the neonatal period, three because of asphyxia. Three of the liveborn infants (0.4%) had Apgar scores at 1 minute between 0 and 3, 40 infants (5.7%) had scores between 4 and 6. After 5 minutes, no infants had Apgar scores between 0 and 3, but three infants had scores between 4 and 6. It is concluded, that the low perinatal mortality and morbidity might indicate, that deliveries in a department of general surgery are safe, provided a specialist obstetrician is available and the rules of referral strictly observed.
