Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: New discoveries

Tamara Caldaro, Erminia Romeo, Paola De Angelis, Rosa Alba Gambitta, Francesca Rea, Filippo Torroni, Francesca Foschia, Giovanni Federici Di Abriola, Luigi Dall'Oglio

Research output: Contribution to journalArticlepeer-review


Background/Purpose: Fecal incontinence and constipation are common problems in follow-up of anorectal malformations (ARMs). We evaluated the anal sphincters using the 3-dimensional endoanal ultrasonography (3D-EAUS) and the anorectal manometry after ARMs repair. Methods: Seventeen patients, divided into 3 groups according to Wingspread classification, underwent anorectal manometry and 3D-EAUS. Clinical, manometric, and endosonographic scoring systems were used. Results: The average anal resting pressure (aARP) was significantly higher in low ARMs than in intermediate and high ARMs. The anal squeeze pressure was not statistically different between the 3 groups. Three-dimensional EAUS visualized internal anal sphincter (IAS) disruptions in 7 of 17 patients and absence of IAS in 6 of 17 children with high ARMs. Scars of the external anal sphincter were localized in low ARMs and generalized in the other groups. In the case of IAS disruption with aARP greater than 20 mm Hg, fecal incontinence and constipation improved with biofeedback and/or laxatives, whereas daily enemas were necessary in absence of IAS with aARP less than 20 mm Hg. Statistical correlation was observed between endosonographic and manometric findings and clinical outcomes. Conclusions: Lesions of the anal sphincter are common in ARMs. Three-dimensional EAUS and anorectal manometry ensure a complete assessment of the anal sphincter and could provide useful information to define the most appropriate treatments to improve the quality of life.

Original languageEnglish
Pages (from-to)956-963
Number of pages8
JournalJournal of Pediatric Surgery
Issue number5
Publication statusPublished - May 2012


  • Anorectal malformations
  • Anorectal manometry
  • Constipation
  • Endoanal ultrasonography
  • Fecal incontinence

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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