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The basic idea of the technique is to introduce a Foley catheter into the anal canal/rectum and marking the midline of the patient anteriorly and posteriorly using an IV line. MRI sequences are then obtained in axial, sagittal and coronal planes, preferably angled for best visualization of the pelvic floor muscles and sphincter mechanism. This techniques has proven to be very valuable in evaluating symmetry of the sphincter around the anus, degree of development of the sphincter muscles and additional evaluation for any pelvic associated abnormalities (e.g pelvic mass, presacral mass, sacral anomalies, spinal cord tethering). However, the study is done in the radiology department, most patient require sedation or General anesthesia, the limited time the radiologist get to spend with the patient physically, lack of muscle stimulators and the setting of the radiology department; all these factors do not allow the radiologist to have time or chance to examine the perineum and what actually ends up happening is placing a Foley catheter into the anus/rectum and marking the midline of the patient and patient is taking to the scanner and scanning begins. The images will be interpreted by the radiologist and all is done. This is a glimpse of our modern every day “Assembly line” model of work at big medical centers. We all get under the pressure of high volume of work, the need to stream work flow for scanners and the urge to keep the waiting list as short as possible. But this could cause errors in interpreting Pena-Patel technique MRI of some of our patients. Because in some of these patients the pull through went through a decent length of the sphincter mechanism and at its distal part happened to be located completely outside the sphincter, mostly posterior to the sphincter, probably to avoid coming too close to the scrotum. This will be found out during clinical examination and stimulation of the muscle of course. But the point here is to improve the outcome of Pena-Patel MRI examination. Hence we recommend marking the site of anal sphincter on the skin by a vitamin E ampule (Metallic markers cannot be used in MRI scanners) in addition to placing the Foley catheter through the rectum and marking the patient midline (Figure 1)."> <meta name="citation_fulltext_html_url" content="https://www.imagejournals.org/articles/pena-patel-technique-a-slight-modification-could-be-really-helpful-460.html"> <meta name="citation_pdf_url" content="https://www.imagejournals.org/articles/pena-patel-technique-a-slight-modification-could-be-really-helpful.pdf"> <style>.heading h1{ margin: 0; color: #fff; font-size: 30px; padding-left: 5px; }</style> </head> <body> <head> <style>.heading h1{ margin: 0; color: #fff; font-size: 30px; padding-left: 5px; }</style> </head> <div class="header-logo-bar"> <div class="container"> <div class="row no-gutters justify-content-between align-items-center"> <div class="col-2 col-md-auto"> <a href="#" class="header-logo"> <img 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class="modal-header"> <h5 class="modal-title" id="fullTextImgLabel">Pena-Patel Technique; A Slight Modification could be Really Helpful</h5> <button type="button" class="close" data-dismiss="modal" aria-label="Close"> <span aria-hidden="true">×</span> </button> </div> <div class="modal-body"> <img class="img-fluid d-flex mx-auto" src="https://www.imagejournals.org//admin/articles-images/460-penapatel-technique-a-slight-modification-could-be-really-helpful-images.jpg" alt="Pena-Patel Technique; A Slight Modification could be Really Helpful"> </div> </div> </div> </div> <div class="row"> <div class="col-12 col-sm-8"> <p class="text-muted"> Clinical Image - International Journal of Clinical & Medical Images (2017) Volume 4, Issue 2 </p> </div> <div class="col-12 col-sm-4 text-right"> <a href="https://www.imagejournals.org/articles/pena-patel-technique-a-slight-modification-could-be-really-helpful.pdf" title="View PDF" class="btn btn-sm bg-green-600 rounded-50"><i class="fas fa-file-pdf"></i> View PDF</a> <a href="https://www.imagejournals.org/pdfdownload.php?download=articles/pena-patel-technique-a-slight-modification-could-be-really-helpful.pdf" title="Download PDF" class="btn btn-sm bg-green-600 rounded-50"><i class="fas fa-file-download"></i> Download PDF</a> </div> </div> <h2 class="mb-3 font-size-24 fweight-600 heading-bullet brd-blue-600-before"> Pena-Patel Technique; A Slight Modification could be Really Helpful </h2> <img class="img-fluid img-thumbnail d-flex mx-auto w-50" data-toggle="modal" data-target="#fullTextImg" src="/admin/articles-images/460-penapatel-technique-a-slight-modification-could-be-really-helpful-images.jpg" title="Click here" alt="Pena-Patel Technique; A Slight Modification could be Really Helpful"> <p><strong>Author(s): </strong>Wael MA Abdalla and Luis De La Torre</p> <div class="text-justify"> <p ><span ><strong><span ><span >Clinical Image: </span></span></strong><span ><span >Pena-Patel technique [1] was introduced to help evaluate the relationship between the anal sphincter mechanism and the anus after pull through done for patients with anorectal malformation (ARM). The basic idea of the technique is to introduce a Foley catheter into the anal canal/rectum and marking the midline of the patient anteriorly and posteriorly using an IV line. MRI sequences are then obtained in axial, sagittal and coronal planes, preferably angled for best visualization of the pelvic floor muscles and sphincter mechanism. This techniques has proven to be very valuable in evaluating symmetry of the sphincter around the anus, degree of development of the sphincter muscles and additional evaluation for any pelvic associated abnormalities (e.g pelvic mass, presacral mass, sacral anomalies, spinal cord tethering). However, the study is done in the radiology department, most patient require sedation or General anesthesia, the limited time the radiologist get to spend with the patient physically, lack of muscle stimulators and the setting of the radiology department; all these factors do not allow the radiologist to have time or chance to examine the perineum and what actually ends up happening is placing a Foley catheter into the anus/rectum and marking the midline of the patient and patient is taking to the scanner and scanning begins. The images will be interpreted by the radiologist and all is done. This is a glimpse of our modern every day “Assembly line” model of work at big medical centers. We all get under the pressure of high volume of work, the need to stream work flow for scanners and the urge to keep the waiting list as short as possible. But this could cause errors in interpreting Pena-Patel technique MRI of some of our patients. Because in some of these patients the pull through went through a decent length of the sphincter mechanism and at its distal part happened to be located completely outside the sphincter, mostly posterior to the sphincter, probably to avoid coming too close to the scrotum. This will be found out during clinical examination and stimulation of the muscle of course. But the point here is to improve the outcome of Pena-Patel MRI examination. Hence we recommend marking the site of anal sphincter on the skin by a vitamin E ampule (Metallic markers cannot be used in MRI scanners) in addition to placing the Foley catheter through the rectum and marking the patient midline (Figure 1).</span></span></span></p> </div> </div> <div class="col-12 col-md-3"><!DOCTYPE html!> <div class="card shadow-sm sidebar mb-3"> <div class="list-group list-group-flush qr_code_image"> <img title="QR" alt="International Journal of Clinical & Medical Images" src="https://chart.googleapis.com/chart?chs=185x185&cht=qr&chl=https%3A%2F%2Fwww.imagejournals.org%2Farticles%2Fpena-patel-technique-a-slight-modification-could-be-really-helpful-460.html&chld=M|0&icqrf=00b1e4" />  <nav class="nav nav-pills social-icons-footer sidebar_social_icons a-pl-0"> <a title="Share This Article" target="_blank" class="nav-link" href="https://www.facebook.com/sharer.php?s=100&p[title]=Pena-Patel Technique; A Slight Modification could be Really Helpful&p[url]=https%3A%2F%2Fwww.imagejournals.org%2Farticles%2Fpena-patel-technique-a-slight-modification-could-be-really-helpful-460.html"><img src="https://www.imagejournals.org/assets/socials/facebook.png" alt="International Journal of Clinical & Medical Images" /></a> <a title="Share This Article" target="_blank" class="nav-link" href="https://web.whatsapp.com/send?text=https%3A%2F%2Fwww.imagejournals.org%2Farticles%2Fpena-patel-technique-a-slight-modification-could-be-really-helpful-460.html" title="Share This Article" target="_blank" class="nav-link"><img src="https://www.imagejournals.org/assets/socials/whatsapp.png" alt="International Journal of Clinical & Medical Images"/></a> <a title="Share This Article" target="_blank" class="nav-link" href="https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.imagejournals.org%2Farticles%2Fpena-patel-technique-a-slight-modification-could-be-really-helpful-460.html" title="Share This Article" target="_blank" class="nav-link"><img src="https://www.imagejournals.org/assets/socials/linkedin.png" alt="International Journal of Clinical & Medical Images"/></a> <a title="Share This Article" target="_blank" class="nav-link" href="https://twitter.com/share?text=Pena-Patel Technique; 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