Perianal Angioleiomyoma: A Case Report and Review of the Literature.

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative.

Anal Pain of an Unusual Cause: Role of Endoanal Ultrasound.

Anal pain is among the most frequent complaints referred in coloproctology clinic. Nevertheless, this symptom may have a great variety of etiopathogenetic causes. This is the first report that highlights the presence of a rare cause of anal pain, originated by ingested seeds. A 65-year-old male had a 4-day history of fever, anal pain, and discharge. A three-dimensional endoanal ultrasound revealed two perianal abscess cavities with central hyperechogenic areas, in the absence of acoustic shadow. The patient underwent examination under epidural anesthesia, where the two cavities were drained endoanally. Two cereal grains (linseed/sunflower seed) were found during the drainage of the abscess. The utilization of endoanal ultrasound in the investigation of perianal pain is a valuable option. In addition, apart from the size and the exact dimensions of abscesses, endoanal ultrasound also permits the clarification even the most remote etiopathogenetic causes of anal pain.

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects. Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.