ANAL ENDOSONOGRAPHY IN PATIENTS WITH ANORECTAL SYMPTOMS AFTER HEMORRHOIDECTOMY

Background Anorectal symptoms after haemorrhoidectomy are common and t reatment is often empirical. Because of this, an audit was carried out of the value of anal endosonography in patients with anorectal sympto ms after haemorrhoidectomy. Methods Between May 1993 and February 1997 , 16 patients (ten men and six women of median age 56 (range 35-77) ye ars) were investigated by anal endosonography for anorectal symptoms a fter haemorrhoidectomy which involved anorectal incontinence (n = 10), anal pain (n = 4) and obstructive defaecation (n = 2). The findings w ere compared with those in a marched group of asymptomatic patients af ter haemorroidectomy, Results Anal endosonography demonstrated an abno rmality in 12 symptomatic patients. Of the ten patients with anorectal incontinence, endosonography showed an internal anal sphincter defect (n = 5), a combined sphincter defect (n = 2) and an isolated external anal sphincter defect (n = 1). Normal appearances were seen in all as ymptomatic patients. The endosonographic abnormalities of the four pat ients with anal pain included internal anal sphincter defect (n = 1), extrinsic mass (n = 1), and intersphincteric abscess (n = 1). One of t he two patients with obstructive defaecation an isolated external anal sphincter defect on endosonography. Conclusion These results show a h igh yield of endosonographic abnormalities in patients who experience symptoms after haemorrhoidectomy, In particular, occult sphincter inju ry as a cause of incontinence in these patients can frequently be demo nstrated.