Abstract
Transperineal ultrasound (TPUS) is a non-invasive, real-time imaging technique increasingly utilized for the evaluation of anorectal and pelvic floor disorders in patients with inflammatory bowel disease (IBD). In ulcerative colitis, it enables accurate assessment of rectal wall thickness and vascularity, which correlate closely with both endoscopic and histological inflammation. This makes it a practical alternative to sigmoidoscopy, especially in settings such as pregnancy, childhood, or long-term disease monitoring. In Crohn's disease, TPUS offers high diagnostic accuracy for detecting, classifying, and monitoring perianal fistulas and abscesses. It is also effective for evaluating rectovaginal fistulas and pouch-related complications following restorative proctocolectomy. Advancements such as color Doppler imaging, contrast-enhanced ultrasound, three-dimensional reconstruction, and computer-assisted grayscale analysis further enhance its diagnostic and functional capabilities. Compared to magnetic resonance imaging and endoscopic ultrasound, TPUS serves as a practical, patient-friendly, and cost-effective frontline or complementary imaging tool for comprehensive disease evaluation and treatment planning-particularly useful in children, pregnant women, and resource-limited settings. Its bedside feasibility, repeatability, and expanding role in treatment monitoring underscore its value in modern IBD care pathways.