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World J Radiol. Apr 28, 2016; 8(4): 370-377
Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.370
Current applications of transperineal ultrasound in gastroenterology
Andreia Albuquerque, Eduardo Pereira
Andreia Albuquerque, Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
Eduardo Pereira, Gastroenterology Department, Hospital Amato Lusitano, 6000-085 Castelo Branco, Portugal
Author contributions: Albuquerque A performed the literature search, provided figures, wrote and revised the paper; Pereira E provided guidance, figures and contributed to the revision of the article.
Conflict-of-interest statement: There is no financial support or relationships that may pose conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreia Albuquerque, MD, Gastroenterology Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal. a.albuquerque.dias@gmail.com
Telephone: +351-22-5512100 Fax: +351-22-5025766
Received: April 4, 2015
Peer-review started: April 4, 2015
First decision: August 31, 2015
Revised: January 23, 2016
Accepted: March 4, 2016
Article in press: March 9, 2016
Published online: April 28, 2016
Processing time: 381 Days and 15.9 Hours
Abstract

Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and non-invasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment). Evacuatory disorders and pelvic floor dysfunction, like rectoceles, enteroceles, rectoanal intussusception, pelvic floor dyssynergy can be diagnosed using this technique. It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature, with images obtained at rest, straining and sustained squeezing. This technique is an accurate examination for detecting, classifying and following of perianal inflammatory disease. It can also be used to sonographically guide drainage of deep pelvic abscesses, mainly in patients who cannot undergo conventional drainage. Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence, postpartum and also following surgical repair of obstetric tears. There are also some studies referring to its role in anal stenosis, for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.

Keywords: Transperineal ultrasound; Inflammatory perianal disease; Posterior compartment; Obstructed defecation; Fecal incontinence

Core tip: Transperineal ultrasound is a technique that has multiple applications, mainly in urology, gynaecology and gastroenterology. Obstructed defecation, inflammatory perianal diseases and fecal incontinence are the principal indications in gastroenterology, but this technique remains almost unknown to most gastroenterologists. It allows for dynamic evaluation of the structures interaction during defecation stimulation manoeuvres, as well as the identification, classification, and follow-up in inflammatory perianal disease, and it can also identify sphincter injury in fecal incontinence. In this review the technique is described and the current evidence that supports its use in several areas is also discussed.