Purpose Pelvic floor injury diagnosis using 3-dimensional (3D) pelvic floor ultrasound or magnetic resonance imaging is unfeasible in many clinics. We assessed the efficacy of a novel diagnostic parameter, the anal canal coronal-sagittal (CS) ratio, for pelvic floor injury on 2D transanal ultrasound.
Methods This retrospective study analyzed the data of 126 female patients who underwent 3D pelvic floor ultrasound (including 2D transanal ultrasound) at a pelvic floor center between August and December 2020. The anal canal CS ratio on 2D transanal ultrasound and pelvic floor avulsion injury measurements were recorded for all patients.
Results A cutoff anal canal CS ratio of 1.15 was obtained using receiver operating characteristic analysis (sensitivity, 0.820; specificity, 0.763; and area under the curve, 0.838). Patients were categorized into the anal canal CS ratio ≥1.15 and the anal canal CS ratio <1.15 groups. Bilateral pelvic floor avulsion was more common in the anal canal CS ratio ≥1.15 group (n=35, 56.5%), and the incidence of pelvic floor avulsion was significantly different between the 2 groups (P=0.001). Existing parameters of pelvic floor injury, including minimal levator hiatus (P=0.001), levator plate descent angle (P=0.001), and levator ani deficiency score (P=0.001), were statistically different between the 2 groups.
Conclusion The anal canal CS ratio was an efficient novel parameter that indirectly detected pelvic floor injury in 2D transanal ultrasound. It is a potential alternative indicator for pelvic floor injury on the widely popular 2D transanal ultrasound.
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Purpose The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.
Methods This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.
Results There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm2 vs. 14.95±2.60 cm2, P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.
Conclusion There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.
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Juvenile polyp makes up 70% to 80% of pediatric colon polyp, and the average age of diagnosis is 2 to 5 years. The treatment of juvenile polyp in children is polypectomy through colonoscopy. The fact that the lumen of intestine is much smaller than that of adults and the need to perform polypectomy is a heavy burden on the endoscopists. Recently, fecal calprotectin (FC) has been found to be related to juvenile polyp. A previously healthy 34-month-old female patient presented to the pediatric gastroenterology department with intermittent bloody stools that were progressively worsening. FC level was abnormally elevated at 2,719 µg/g (normal, < 50 µg/g). The polyp was successfully removed with a endoscopic polypectomy. This is the first case in Korea to show that FC can be used to screen juvenile polyp in children. Caution must be taken that FC levels can increase with inflammation, regardless of the number or size of the polyps.
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PURPOSE Preoperative assessment of the depth of invasion in the rectal wall and of lymph node metastases is very important in determining the treatment modality in rectal cancer. The purposes of study were to evaluate the accuracy of transrectal ultrasonography (TRUS) in preoperative staging of rectal cancer and to compare that accuracy with the accuracy for computed tomography (CT). METHODS We reviewed 59 patients who were diagnosed as having rectal cancer and who had been staged by using TRUS and CT preoperatively. Ultrasonographic tumor (uT) and nodal (uN) stage and computerized tomographic tumor (cT) and nodal (cN) stage were entered into the database prospectively. The accuracy of each staging was compared with the pathologic staging. The accuracy, the sensitivity, the specificity, the positive predictive value, and the negative predictive value of each diagnostic test were calculated. Chi- square tests were conducted to identify the factors influencing the accuracy. RESULTS The accuracies of TRUS and CT in assessing the depth of invasion were 66.1% and 62.5%, respectively. The accuracies of TRUS and CT in assessing the nodal involvement in patients treated with radical surgery were 70.4% and 63.6%, respectively. For detection of fat infiltration, the sensitivities were 97.4% for TRUS and 76.3% for CT. The specificities were 45.0% for TRUS and 55.6% for CT. The sensitivities for detection of lymph node involvement were 59.3% for TRUS and 42.9% for CT. The specificities were 81.5% for TRUS and 85.2% for CT. The gross appearance of the tumor had a significant influence on the assessment of the depth of invasion (P=0.015). In 9 out of 77 patients (11.7%) could not be performed the TRUS examination due to obstruction or the location of the tumor. CONCLUSIONS In spite of some limitations, TRUS is considered a very useful tool in the preoperative assessment of the depth of invasion and of the lymph node involvement in rectal cancer. However, CT examination is mandatory to overcome the limitations of TRUS in the preoperative diagnosis of rectal cancers.