Anorectal echoendoscopy: applications in pediatrics

Pediatric indications: Anorectal echoendoscopy is widely used in adults for the pretreatment work-up of rectal cancer and for the exploration of fecal incontinence. it can also be useful in the pediatric setting as recently d escribed with relative or linear heads. The exploration can be performed af ter an evacuating enema or if needed after giving a neuroleptanalgesic. The anorecal walls and neighboring areas-bladder, genital organs, perirectal s paces, vessels-can be explored. The ultrasonographic aspect of the walls is similar to that described in adults although less thick, particularly at t he level of the anus sphincters. Signs of defects, abscesses and fistulizat ions are the same as in adults. Bowel disorders and incontinence: Echoendoscopy can characterize rare subep ithelial tumors of the rectum and vascular anomalies, but its main interest is for the exploration of bowel disorders and incontinence, particularly a fter surgical treatment for anorectal malformations. The quality of the mus cular tissue and the quality of the surgical repair can be assessed before deciding on the need for a second operation. In this context, anorectal ech oendoscopy can also disclose Hirschsprung's disease and other forms of idio pathic megarectum, including certain types with major thickening of the int ernal sphincter. II can also detect defects induced by prior disimpaction m aneuvers. A noninvasive exam: Anorectal echoendoscopy is a promising exploration tech nique in pediatric gastroenterology. Descriptions of the sphincters and ano rectal anatomy are very precise and descriptions of functional disorders, w hether primary or secondary to surgery, can be guile helpful for guiding su bsequent management.