ENDOSONOGRAPHIC EVALUATION OF THE RECTUM IN CHILDREN WITH EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION

Rectal endoscopic ultrasonography (REUS) was performed using an Olympu s EU-M3 ultrasound fiberscope in 25 children with extrahepatic portal venous obstruction (median age of 8, range 3-16 years) and in eight co ntrol subjects (median age of 8, range 6-13). Rectal varices (tortuous or nodular distended veins seen beneath the mucosa) and portal hypert ensive rectopathy were diagnosed endoscopically. At rectal endosonogra phy, rectal varices were seen as rounded, oval, or longitudinal echo-f ree structures in the submucosa. Perirectal veins outside the rectal w all were also seen in REUS. Portal hypertensive rectopathy was endosco pically observed in nine (36%) patients. Rectal varices were detected by endoscopy in nine (36%) and by endosonographic examination in 19 (7 6%) patients with extrahepatic portal venous obstruction. The number ( 2, range 0-10) and size (3, range 0-4.5 mm) of submucosal veins seen o n endosonography in patients were greater than in controls (0, range 0 -1, and 0, range 0-2 mm; p < 0.001 for both). The size of perirectal v eins was greater in patients than in controls (3.5, range 3-5 mm versu s 2.5, range 2-3 mm; p < 0.001). Communicating veins between the submu cosal and perirectal veins were seen in nine (36%) patients. Rectal en doscopic ultrasonography was superior to endoscopy in detecting the pr esence of rectal varices (76% versus 35%, p < 0.005). Our study sugges ts that endosonography is useful in detecting changes in the rectal an d perirectal vasculature in patients with extrahepatic portal venous o bstruction.