Internal anal sphincter evaluation using 3D anal ultrasound.

A 42 year-old male, with no relevant medical history except surgery three years before for chronic anal fissure in another center (without information regarding type of surgery), attended outpatient clinic for several week-history of anal pain. The patient related a sudden anal pain without irradiation and without relationship with defecation that improved with flexion of the lower extremities. On physical examination, the patient has no pain and there were no relevant findings. 3D endoanal ultrasound showed a defect in the internal anal sphincter on the left half of the anal canal (Figs. 1 and 2). This image was highly suggestive to be secondary to have been operated using a lateral sphincterotomy technique. The patient was diagnosed with chronic idiopathic anal pain type Proctalgia fugax and he was successfully treated with topical diltiazem.