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Fig. 11 —Three-dimensional endoanal sonogram at midanal canal of
37-year-old woman shows large obstetric tear involving both internal anal
sphincter (open arrows, IS) from 10- to 5-o'clock positions and
external anal sphincter (arrowheads, ES) from 10- to 3-o'clock
positions after complicated vaginal delivery. Tears are visualized by
discontinuity of inner and outer sphincter rings. Scar tissue (solid thin
arrows) of external anal sphincter is depicted anteriorly by segments of
hypoechogenicity. Top of figure is anterior.