Atlas Of Endoanal And Endorectal Ultrasonography

With contributions by numerous experts

Three-dimensional endoanal ultrasonography with emphasis on the anatomy of the pelvic floor and diagnosis of anorectal benign diseases. Numerous schematic representations coupled with ultrasonographic and radiologic images provide a didactic approach. Readers gain a clear understanding of the fundamental principles and techniques of ultrasonography as well as of the normal anatomy of the pelvic floor and its modification in various benign anorectal diseases. Both general and specialist clinical practices will benefit from this book.

It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

Nowadays, we are dealing more frequently with the entity of large intestine polyps, as endoscopy and bowel cancer screening programmes are rapidly expanding. Often a single polyp is involved, but more complex situations are also encountered, including the well-defined pattern of polyposis. These situations can fall into a gray area, not only for diagnosis, but also for the correct treatment and follow-up. New developments in pathophysiology and treatment options are leading to new questions. This handbook aims to offer a integrated approach for all physicians (doctors) who deal with these issues, by presenting up-to-date discussion from genetics through treatment, to implications of genetic counseling. It will also help specialists to offer more "evidence-based" treatments, by implementing the best clinical individual judgement informed by the best current scientific evidence.

Inflammatory bowel disease (IBD) and familial adenomatous polyposis (FAP) are complex diseases. Despite increased knowledge on the pathophysiological process, many aspects remain rather unclear, especially concerning IBD. This book gathers current methods of treatment of these diseases and also presents the management of their complications. The authors give a comprehensive overview of the newer therapies to bring readers up to date.

Despite lifestyle improvements, the incidence of rectal cancer is increasing in industrialised countries. Rapid advances in technology, growing knowledge of the biological history of the disease and closer attention to patients' quality of life after surgery have led to a less invasive approach. In the last 15 years, the surgical approach has shifted from extended resection to sphincter-saving procedures, featuring a multidisciplinary approach and a high level of specialisation. The experienced surgeon can plan and choose the "right treatment for the right patient" only with the support of the radiologist, endoscopist and pathologist (preoperative staging), oncologist and radiotherapist (neoadjuvant therapy), and psychologist and stomatherapist (rehabilitation). In addition, the difficult problems of salvage procedure and the reconstruction of anal sphincter after abdominal resection are explored. The aim of this book is to clarify the rapid advances and to offer guidelines for doctors dealing with rectal cancer. Taking into account indications, contraindications, risks, benefits and controversies, the authors offer clear and practice-oriented answers for a wide range of specialists and experts, as well as those new to the field.

Three-dimensional endoanal ultrasonography with emphasis on the anatomy of the pelvic floor and diagnosis of anorectal benign diseases. Numerous schematic representations coupled with ultrasonographic and radiologic images provide a didactic approach. Readers gain a clear understanding of the fundamental principles and techniques of ultrasonography as well as of the normal anatomy of the pelvic floor and its modification in various benign anorectal diseases. Both general and specialist clinical practices will benefit from this book.

This practical volume is intended for all radiologists, gastroenterologists, and surgeons who are responsible for, or interested in, the diagnosis and care of patients with diseases of the anal and perianal region. After an introductory section focusing on surgical, MRI, and US anatomy, up-to-date clinical and therapeutic information is provided on the full range of perianal inflammatory conditions, with special attention to Crohn’s disease, ulcerative colitis, and sexually transmitted diseases. Physical and surgical examination is carefully discussed, with consideration of limitations, results, clinical needs, and the questions likely to be posed of imaging. The subsequent three sections provide detailed information on the different imaging modalities: transanal and transperineal ultrasound, contrast-enhanced MRI, and CT. Techniques, diagnostic accuracy, common and unusual disease patterns, artifacts, and pitfalls are clearly presented.