RADIOLOGICAL ANANTOMY

OF
RECTUM AND ANAL CANAL
TOPICS COVERED:
1. CONVENTIONAL RADIOLOGY
2. USG
3. CT scan
4. MRI
5. Classification of perianal fistulas
 BARIUM STUDIES

Barium enemas provided good anatomical detail from

the rectum to the cecum. The patient may need to be
rolled into various positions to get the barium to coat the
lumen of the colon
SINGLE CONTRAST STUDY
• The colon is filled with barium, which outlines the
intestine and reveals large abnormalities

DOUBLE CONTRAST with AIR

• The colon is first filled with barium

• then the barium is drained out, leaving only a thin
layer of barium on the wall of the colon.
• The colon is then filled with air. This provides a detailed
view of the inner surface of the colon, making it easier to
see narrowed areas (strictures), diverticula, or
inflammation.
Proctography may be viewed in three stages: rest,
evacuation and recovery.
At rest, the anorectal junction is normally just above
the plane of the ischial tuberosities.
Evacuation is initiated by 3 cm descent of the pelvic floor,
widening of the anorectal angle, and relaxation of the anal
sphincters.
The rectum distal to the main fold is squeezed by raised
intra-abdominal pressure against the levator ani to form
a ‘zone of evacuation’ that empties in less than 30 s. On
MRI proctography, organ prolapse is conventionally
measured with respect to the pubococcygeal line.
RECTAL ULTRASOUND
• Uses a 360 degree rotating endoprobe.
• Obtains high resolution axial images of the
rectal wall.
• Primarily used to stage tumors.

ANAL ENDOSONOGRAPHY
• Modified rectal endoprobe to image the anal
sphinctersin patients who are anally
incontinent.
Normal male endosonographic mid anal canal
anatomy. The internal anal sphincter (IAS) is a hyporeflective
structure. The external anal sphincter (EAS) is commonly
hyporeflective in comparison to the surrounding fat. Women
tend to have a more echogenic EAS. The longitudinal muscle
(LM) can also be seen in the intersphincteric plane. The subepithelium
(SE) is of quite variable thickness and is generally
echogenic.
Transvaginal semicircular transverse ultrasound image of the perineal body and anal
canal. The perineal membrane (2) and the puboperineal muscle (3) meet in the
perineal body(1).
5- external anal sphincter
7- internal anal sphincter
ANAL CANAL
•The anal canal comprises 2 muscular cylinders.
•The internal anal sphincter is the inner cylinder which is 3-cm long
thickened extension of the rectal circular smooth muscle and extends from
the ano-rectal junction to about 1–1.5 cm beneath the dentate line.
•The external anal sphincter is the outer cylinder which is a 4-cm
long downward extension of the pubo-rectalis muscle.
•The pectinate or the
dentate line lies in the
middle part of the internal
anal sphincter and it
separates the rectal
transitional and columnar
epithelium from the anal
squamous epithelium.
•At this dentate line; the
anal crypts are located.
Anal glands are seen at the
basal part of many of the
crypts and infrequently
penetrate into theinter-
sphincteric space
CLASSIFICATION OF
PERIANAL FISTULAS
The classification system developed by Parks, Gordon, and
Hardcastle (generally known as the Parks classification) is the
one most commonly used for fistula-in-ano. This system
defines four types of fistula-in-ano in coronal plane:

intersphincteric (~70)

transsphincteric (25%): 

suprasphincteric (5%): 

extrasphincteric (1%): 
St James’s University Hospital Classification
In this classification the fistulae were graded into five
grades:
Grade 1: simple inter-sphincteric linear fistula
Grade 2: inter-sphincteric with abscess or secondary
track
Grade 3: trans-sphincteric
Grade 4: trans-sphincteric with abscess or secondary
track in
the ischio-anal or ischio-rectal fossae
Grade 5: supra-levator and trans-levator.
THANK YOU