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La radiologia medica

, Volume 113, Issue 6, pp 887–894 | Cite as

Iatrogenic rectal diverticulum in patients treated with transanal stapled techniques

  • M. E. AlabisoEmail author
  • R. Grassi
  • C. Fioroni
  • I. Marano
Gastrointestinal radiology/Radiologia gastrointestinale

Abstract

Purpose

The aim of this study was to demonstrate the possibility of rectal diverticula developing in patients treated with endoanal circular staplers for haemorrhoids (Longo’s stapled haemorrhoidectomy) or obstructed defaecation syndrome [stapled transanal rectal resection (STARR)].

Materials and methods

Between January 2005 and December 2006, we carried out 634 defaecographic examinations. Of these, 45 were postoperative follow-up studies of patients who had been treated with the Longo technique (n=13) or STARR technique (n=32).

Results

Seven out of 45 patients, five of whom were women treated with the Longo technique and two men with the STARR technique, developed rectal diverticula. One diverticulum was located on the left lateral rectal wall, four on the posterior wall and two on the anterior wall. All diverticula had arisen from the surgical suture point. In one case, the diverticulum was discovered incidentally during a double-contrast barium enema. One of the male patients, who had been treated with the Longo procedure 5 years earlier, developed acute pain due to faecal stasis in a widenecked diverticulum abutting the posterior rectal wall.

Conclusions

The use of endorectal stapling devices can lead to focal weakness at the point of surgical suture on the rectal wall and predispose to the development of rectal diverticula.

Keywords

Circular stapler Defecography Rectal diverticulum 

Diverticolo rettale iatrogeno in pazienti trattati con suturatrici meccaniche circolari endoanali (stapler)

Riassunto

Obiettivo

Scopo del lavoro è dimostrare che l’uso di suturatrici meccaniche circolari (stapler) per il trattamento di patologia emorroidaria (Longo) o di ODS (STARR) può determinare l’insorgenza di un diverticolo rettale.

Materiali e metodi

Tra gennaio 2005 e dicembre 2006 sono stati valutati con esame defecografico 634 pazienti di cui 45 erano stati sottoposti ad intervento chirurgico, 13 di Longo e 32 di STARR.

Risultati

In 7/45 pazienti, 5 operati di Longo e 2 di STARR, è stato riscontrato un diverticolo rettale. Di questi (5 in pazienti di sesso femminile e 2 in pazienti di sesso maschile) 1 era localizzato a livello della parete laterale sinistra, 4 della parete posteriore e 2 di quella anteriore. Tutti erano situati a livello della sutura chirurgica. In un caso si è trattato di un riscontro occasionale durante l’esecuzione di un clisma del colon a doppio contrasto. Uno dei pazienti maschi, operato di Longo da 5 anni, presentava acuta sintomatologia dolorosa dovuta al ristagno fecale nel diverticolo, che presentava ampio colletto, ed al decubito dello stesso sulla parete posteriore dell’ampolla rettale.

Conclusioni

Con l’uso di suturatrici meccaniche endorettali è possibile l’instaurarsi di aree di debolezza focale della parete rettale, in corrispondenza della sutura chirurgica, che possono rappresentare punti di minor resistenza e quindi fattore predisponente all’insorgenza di un diverticolo rettale.

Parole chiave

Suturatrice meccanica (stapler) Defecografia Diverticolo rettale 

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Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • M. E. Alabiso
    • 1
    Email author
  • R. Grassi
    • 2
  • C. Fioroni
    • 3
  • I. Marano
    • 1
  1. 1.UOC di Radiologia, PO Cardinale Ascalesi - ASL Na 1NapoliItaly
  2. 2.Dipartimento di Internistica Clinica e SperimentaleF. Magrassi, A. Lanzara, Sezione Scientifica di Diagnostica per Immagini - SUNNapoliItaly
  3. 3.Dipartimento di Diagnostica per ImmaginiOspedale Santa Maria della Misericordia, Azienda Ospedaliera di PerugiaPerugiaItaly

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