Endosonographie bei benignen proktologischen Erkrankungen

Zusammenfassung

Die anorektale Endosonographie ist bei verschiedenen Erkrankungen von Anus, Rektum und Beckenboden einsetzbar. Vergleichbar mit der Rektoskopie oder Proktoskopie ist die Endosonographie ein einfach durchzuführendes und valides Diagnostikum ohne wesentliche Patientenbelastung. Primär wurde die anorektale Endosonographie für das Tumorstaging evaluiert, jedoch nur kurze Zeit später wurde die Bedeutung dieses Untersuchungsverfahrens für gutartige anorektale Erkrankungen evident. Die Muskulatur des Analsphinkters kann klar dargestellt werden, der innere und der äußere Schließmuskel kann unterschieden werden. Weitere Beckenbodenstrukturen, wie die Puborektalisschlinge, der Levatormuskel und die Organe des kleinen Beckens lassen sich visualisieren. Eine besondere Bedeutung hat die Endosonographie in der Sphinkterdiagnostik, insbesondere in der Diagnostik von Sphinkterdefekten und in der postoperativen Kontrolle nach Schließmuskelrekonstruktion. Ein weiteres endosonographisches Indikationsfeld sind perianale Abszesse oder Analfisteln. Lokale Schmerzen oder Stenosen limitieren gelegentlich diese Untersuchungsmethode. Die anorektale Endosonographie stellt ein kostengünstiges, rasch verfügbares Diagnostikum für alle Arten anorektaler Erkrankungen dar. Ausbildung, Standardisierung und Qualitätskontrolle sind wichtig und bedürfen einer weiteren Evaluation.

Abstract

Anorectal endosonography may be used for diagnosing various disorders of the anus, rectum and pelvic floor. Similar to rectoscopy or proctoscopy anal endosonography is easy to perform and discomfort for the patient is low. Anorectal endosonography was first described in tumor staging, but short time later the value of endosonographic imaging became evident in benign anorectal disorders. Anal sphincter can be clearly visualized and distinction is possible between external and internal anal sphincter. Other pelvic structures can be visualized like M. levator or the puborectalis muscle. Endosonography is important in diagnosing sphincter pathologies, in localizing sphincter defects and controlling the result of sphincter repair. In anorectal or perineal sepsis, endosonography is a useful tool in defining localization of an abscess or a fistula tract. Limitations of endosonography are local pain or stenosis. Conclusion: Anal endosonography is a non expensive and useful diagnostic procedure for benign anorectal disorders. Teaching, training, standard investigation procedure and quality control in endosonography are important and require further evaluation.

Schlüsselwörter

Anale Endosonographie - Analsphinkter - Inkontinenz - Analfistel - Analabszess

Key words

Anal endosonography - Anal sphincter - Anal incontinence - Perianal fistula - Perianal abscess

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