THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D...
Transcript of THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D...
![Page 1: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/1.jpg)
THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL ULTRASOUND GIVES A
NEW TREND IN COLORECTAL SURGERY
Dr. Kaspars SnipeRiga Eastern Clinical University Hospital (RAKUS), Riga, Latvia
![Page 2: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/2.jpg)
3D TRUS and colorectal surgery
• The results of treatment depend on precise diagnose:
– rectal fistula
– anal sphincters lesions
– pelvic floor muscles damages
– ODS
– malignant rectum diseases
– others benign diagnoses (such endometrioses, presacral cyst)
![Page 3: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/3.jpg)
History
• Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor. Wisser J, Schär G, Kurmanavicius J, Huch R, Huch A. Department of Obstetrics, University Hospital Zurich, Switzerland Ultraschall in der Medizin 1999 Feb;20(1):15-8
3D ultrasound can now be used to examine pelvic floor
anatomy and to detect changes associated with
trauma to the pelvic floor following vaginal delivery.
![Page 4: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/4.jpg)
• Controversial issue:– 3D TRUS or MR
CONCLUSION: 3D EUS and endoanal MRI
are comparable for detecting EAS defects.
• Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging. West RL, Dwarkasing S, Briel JW, Hansen BE, Hussain SM, Schouten WR, Kuipers EJ. Int J Colorectal Dis. 2005 Jul;20(4):328-33. Epub 2005 Jan 22.
3D TRUS and colorectal surgery
![Page 5: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/5.jpg)
3D US and colorectal surgery
• US examination for rectum and perineum:
– Anal canal
– Ampula of rectum (10-12-15cm)
– Dynamic transperineal investigation
![Page 6: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/6.jpg)
Anal canal
• Assessment of muscles of anal canal
EAS
EAS
IAS
![Page 7: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/7.jpg)
Anal canal
M.puborectalis
![Page 8: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/8.jpg)
Ampula of rectum– Rectum wall and Pararectal tissue
Interface
Mucosae
Submucosae
Muscolaris propria
Perirectal fat
![Page 9: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/9.jpg)
Dynamic transperineal investigation
• Relations between organs
– Push
– Strain
• Rectocele
• Enterocele
• Cystocele
![Page 10: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/10.jpg)
Rectal fistula
• Pathology with high recurrent rate
• The providential point - detecting of internal opening
![Page 11: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/11.jpg)
3D TRUS
![Page 12: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/12.jpg)
3D TRUS
![Page 13: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/13.jpg)
Anal sphincters lesions
• Trauma during delivery
• Iatrogenic lesions
• Where are the lesions?
• Is possible to reconstruct?
![Page 14: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/14.jpg)
Anal sphincters lesionsWomen 32 y.o. After delivery
![Page 15: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/15.jpg)
Reconstruction of anal canal
![Page 16: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/16.jpg)
Reconstruction of anal canal
![Page 17: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/17.jpg)
Reconstruction of anal canal
Perineum high 4.5 cm
![Page 18: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/18.jpg)
Pelvic floor muscles damages
• Sphincter of urethra, vaginae and anal canal are on the one axis
Sphincter of urethra
Vaginae
Rectum
![Page 19: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/19.jpg)
Pelvic floor muscles damages
• The deviation of rectum indirectly present the m.levator ani injury in opposite site
![Page 20: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/20.jpg)
ODS (Obstructive defecation syndrome)
![Page 21: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/21.jpg)
ODS (Obstructive defecation syndrome)
![Page 22: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/22.jpg)
Malignant rectum diseases
• Invasion-muscolaris propria
• Local positive lymphnodes
![Page 23: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/23.jpg)
Malignant rectum diseases
![Page 24: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/24.jpg)
Malignant rectum diseases
![Page 25: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/25.jpg)
Malignant rectum diseases
• Patient A.B. 80 y.o. T2N0M0
![Page 26: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/26.jpg)
Others benign diagnoses
• Endometriosis
• Presacral cyst
![Page 27: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/27.jpg)
Endometriosis
![Page 28: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/28.jpg)
Endometriosis
![Page 29: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/29.jpg)
Presacral cyst
![Page 30: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/30.jpg)
Presacral cyst
![Page 31: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/31.jpg)
Rectum-bar
![Page 32: THE 3DIMENSIAL ENDOANAL AND TRANSRECTAL …radiologija.lt/content/download/1314/5764/file/Snipe_3D TRUS_BCR10.pdf3D EUS and endoanal MRI are comparable for detecting EAS defects. •](https://reader031.fdocuments.us/reader031/viewer/2022011822/5eca835203c04e49820bf903/html5/thumbnails/32.jpg)
Thank you!