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(Radiology. 2000;217:392-394.)
© RSNA, 2000

Pediatric Imaging

US Identification of the Anal Sphincter Complex and Levator Ani Muscle in Neonates: Infracoccygeal Approach1

Tae Il Han, MD, In-One Kim, MD, Woo Sun Kim, MD, Jin Young Chung, MD, Kyuchul Choeh, MD, Mun Kab Song, MD and Yong Gyu Yoon, MD

1 From the Departments of Radiology (T.I.H., J.Y.C., M.K.S., Y.G.Y.) and Pediatrics (K.C.), Eulji University School of Medicine, 24-14 Mok-Dong, Jung-Gu, Taejon 301-726, South Korea, and the Department of Radiology, Seoul National University College of Medicine, South Korea (I.O.K., W.S.K.). From the 1999 RSNA scientific assembly. Received December 23, 1999; revision requested January 30, 2000; revision received April 3; accepted April 20. Address correspondence to T.I.H. (e-mail: tihan@emc.eulji.ac.kr).

PURPOSE: To identify the anal sphincter complex and levator ani muscle at transperineal ultrasonography (US) with the infracoccygeal approach.

MATERIALS AND METHODS: Infracoccygeal US was performed with a 7-MHz linear-array transducer in 40 healthy neonates. The babies were placed in the supine position, and both legs were drawn up to the chest. The buttocks were accordingly lifted up. The approach site was just inferior to the coccyx and posterior to the anus. Scanning was performed to obtain transverse images of the anorectal area. The thickness of the anal sphincter complex and the puborectalis muscle were measured.

RESULTS: Infracoccygeal US revealed the internal anal sphincter (IAS), the external anal sphincter (EAS), and the puborectalis muscle in all babies. The IAS and EAS were depicted as inner and outer hypoechoic ringlike structures, respectively. A round, hyperechoic space (intersphincteral space) was present between the hypoechoic IAS and EAS. The puborectalis muscle was identified as a U-shaped hypoechoic structure. The bulbocavernosus and ischiocavernous muscles were also identified. Mean thicknesses were as follows: IAS, 1.3 mm ± 0.3 (SD) (range, 0.8–1.9 mm); EAS, 1.6 mm ± 0.3 (range, 1.2–2.3 mm); and puborectalis muscle, 1.1 mm ± 0.3 (range, 0.6–1.9 mm).

CONCLUSION: Infracoccygeal transperineal US is an excellent diagnostic modality for demonstrating the anal sphincter complex and levator ani muscle in neonates.

Index terms: Anus, US, 757.1298, 757.92 • Infants, newborn, gastrointestinal tract, 757.92 • Ultrasound (US), in infants and children, 757.1298




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T. I. Han, I.-O. Kim, and W. S. Kim
Imperforate Anus: US Determination of the Type with Infracoccygeal Approach
Radiology, July 1, 2003; 228(1): 226 - 229.
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