Maaike P Terra MD, Presenter: Nothing to Disclose

Marije Deutekom MS, Abstract Co-Author: Nothing to Disclose

Regina Beets-Tan, Abstract Co-Author: Nothing to Disclose

Alexander F Engel, Abstract Co-Author: Nothing to Disclose

Lucas W.M. Janssen, Abstract Co-Author: Nothing to Disclose

Jaap Stoker, Abstract Co-Author: Nothing to Disclose

External anal sphincter (EAS) atrophy at endoanal MRI is an indicator for poor outcome of surgery for an EAS defect (sphincter repair). We wanted to study the relation between EAS atrophy at endoanal MRI and clinical, functional, and anatomical information in patients with fecal incontinence due to mixed aetiologies.

In 202 patients with fecal incontinence endoanal MR images were evaluated for EAS atrophy, graded as none, mild or severe. Subgroups of patients, based on presence and degree of EAS atrophy, were tested on differences in data derived from medical history, anal manometry, pudendal nerve latency testing and anal sensitivity testing, as on differences in EAS thickness measurements and defects.

EAS atrophy was demonstrated in 123 of 202 patients (61%), graded as mild in 79 (39%) and severe in 44 patients (22%). Patients with EAS atrophy were predominantly female (P<0.001) and older (p=0.002), and could not be identified by other clinical, functional or anatomical characteristics, except for a lower maximal squeeze (p=0.007) and squeeze increment pressure (p=0.001). Maximal squeeze (p=0.003) and squeeze increment pressure (p<0.001) were lower in patients with severe compared to patients with mild atrophy. These effects were not affected by sex, age, type of anal manometry technique used, and coexistence of an external anal sphincter defect.

EAS atrophy was demonstrated at endoanal MRI in 61 percent of patients with fecal incontinence, graded as mild in 39 percent and as severe in 22 percent of patients. As EAS atrophy had a great impact on squeeze function and squeeze function deteriorated by increasing degree of atrophy, further studies needs to evaluate if grading atrophy is of clinical value in selecting patients for sphincter repair.

Terra, M, Deutekom, M, Beets-Tan, R, Engel, A, Janssen, L, Stoker, J, External Anal Sphincter Atrophy at Endoanal MR Imaging in Patients with Fecal Incontinence.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4413564.html