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Rectal Intussusception (rectal + intussusception)

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Medical Sciences	100%

Selected Abstracts

Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2008
A. D'Hoore
Background: Rectocele can be part of a more complex rectal prolapse syndrome including rectal intussusception and enterocele. This reflects insufficiency at different levels of support in the posterior pelvic compartment. A new technique involving reinforcement of the rectovaginal septum with mesh by a combined laparoscopic and perineal approach was evaluated. Methods: The study included 18 patients with a complex rectocele and grade 2,3 rectal intussusception and enterocele (eight patients). Patients had clinical, physiological and radiological follow-up. Results: There was no major perioperative morbidity and mean hospital stay was 4·5 (range 3,7) days. After a mean of 24·2 (range 13,35) months there was no clinical recurrence of rectocele. Symptoms of obstructed defaecation resolved in 14 of 17 patients. The Patient Assessment of Constipation Symptoms score decreased from a mean(s.d.) of 12·6(5·9) to 3·9(4·2), and a rectocele symptom score from 14·3(3·3) to 2·3(2·8). No new-onset constipation, urge or faecal incontinence nor new-onset dyspareunia was reported. Radiological investigation in eight patients revealed a sufficient anatomical repair at the different levels of support. A slight decrease in rectal compliance was measured, with no significant reduction in rectal capacity. Conclusion: Complete rectovaginal septum reinforcement with mesh corrected complex rectoceles, with good functional outcome. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Anorectal three-dimensional endosonography and anal manometry in assessing anterior rectocele in women: a new pathogenesis concept and the basic surgical principle

COLORECTAL DISEASE, Issue 1 2007
F. S. P. Regadas
Abstract Objective, The anatomy of the anal canal, the anorectal junction and the lower rectum was studied with 3-D ultrasound. Method, Seventeen women with normal bowel transit, without rectocele (group 1) and 17 female patients with a large anterior rectocele (group 2) were examined with a B&K Medical Rawk®. Mean age was 44.5 and 51.6 years respectively. In group 1, one (5.8%) patient was nuliparous, five (29.4%) had a caesarian section, 11 (64.7%) had a vaginal delivery while in group 2, two (11.7%) patients were nuliparous, four (23.5%) had a caesarian section and 11 (64.7%) had a vaginal delivery. Images were reconstructed in midline longitudinal (ML) and transverse (T) planes. The external (EAS) and internal (IAS) anal sphincters were measured in both projections. Results, In the ML plane, the EAS length was longer in group 1 (1.94 cm vs 1.61 cm, P < 0.05), the gap length was shorter (1.54 cm vs 1.0 cm P < 0.01) and the wall thickness was shorter in group 2 (0.40 cm vs 0.50 cm P < 0.01). The IAS (0.18 cm vs 0.23 cm P < 0.01) and EAS thickness (0.68 cm vs 0.77 cm, P < 0.05) (left lateral of the posterior quadrant) was greater in group 2. In group 1, the anterior upper anal canal wall in normal females was an extension of the rectal wall and the circular muscle was thicker in the mid-anal canal to form the IAS. In group 2, however, the wall layers were not identified and the IAS was found to be more distal. The differences were not statistically significant in the anal canal resting and squeeze pressures in the two groups. Conclusion, Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination ,rectocele' should be changed to ,anorectocele'. [source]

Open-magnet MR defaecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception

COLORECTAL DISEASE, Issue 1 2004
L. S. Dvorkin
Abstract Objective The aim of this study was to determine whether open-magnet magnetic resonance (MR) defaecography could provide more useful clinical information than evacuation proctography (EP) alone in the evaluation of a cohort of patients with full-thickness rectal intussusception and could assist in decisions concerning management. Methods Ten patients (4 male; median age 43, range 30,65) with symptomatic circumferential rectal intussusception diagnosed on EP, underwent open-magnet MR defaecography. Pathologies visible with each technique were recorded and 12 parameters of anorectal configuration and morphology measured and compared. Results There was discordance in the diagnosis of rectal intussusception in three cases. In another two patients, MR defaecography demonstrated mucosal descent only. Measurements of anorectal configuration and morphology were similar between techniques; only rectal size and lateral dimensions of the rectocoele were significantly different, being smaller on MR defaecography than EP. Two patients were shown on MR defaecography to have significant bladder descent and two female patients had significant vaginal descent. Conclusion EP remains the first line investigation for the diagnosis of rectal intussusception, but may not distinguish mucosal from full-thickness descent. MR defaecography further complements EP by giving information on movements of the whole pelvic floor, 30% of the patients studied having associated abnormal anterior and/or middle pelvic organ descent. If surgery is planned for patients with rectal intussusception, MR defaecography provides useful information regarding the presence and degree of anterior pelvic compartment descent that may need to be addressed if a good functional outcome is to be achieved. [source]