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Idiopathic megarectum in adults

An assessment of manometric and radiologic variables

  • Intestinal Disorders, Inflammatory Bowel Disease, Irritable Bowel Syndrome, and Immunology
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Abstract

Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipation. However, outlet obstruction itself may be due to several mechanisms. Among these, the presence of a megarectum is a leading one. Pathophysiological studies in adult patients with idiopathic megarectum are scarce. We studied by manometric and defecographic means 15 adult subjects with idiopathic megarectum and severe chronic constipation. Twenty-five healthy volunteers of both sexes acted as controls. Manometric variables showed significant differences between patients and controls with respect to internal anal sphincter pressure (P=0.02), minimum relaxation volume (P<0.001), defecatory sensory threshold (P<0.001), mean rectal tolerable volume (P<0.001), and rectal compliance (P<0.001). An altered response to straining was observed in 46.6% of patients and in 12% of controls (P=0.04); the ability to expel a 50-ml balloon per anum was 13.3% in patients and 100% in controls (P<0.001). Although all patients opened the anorectal angle and had descent of the pelvic floor, thereby confirming an adequate expulsion effort, evacuation of contrast material appeared extremely difficult. In fact, no subject was able to expel more than 30% of the rectal contents during fluoroscopic screening. These results confirm previous hypotheses that idiopathic megarectum displays features of a neuropathic process as an underlying mechanism. Further studies are needed that also take into consideration the muscle tone component of the rectum in these patients.

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Authors and Affiliations

  1. Divisione di Ribilitazione Gastroenterologica, Sezione di Radiologia, Ospedale Clinicizzato di Valeggio sul Mincio, Università degli Studi di Verona, Italy

    Giuseppe Chiarioni MD,  Gabrio Bassotti MD, PhD, Ugo Germani MD, Paolo Brunori MD, Maria Teresa Brentegani MT, Guglielmo Minniti MD, Calcedonio Calcara MD, Antonio Morelli MD & Italo Vantini MD

  2. Laboratorio di Motilità Intestinale, Clinica di Gastroenterologia ed Endoscopia Digestiva, Dipartimento di Medicina Clinica, Patologia e Farmacologia, Università degli Studi di Perugia, Italy

    Giuseppe Chiarioni MD,  Gabrio Bassotti MD, PhD, Ugo Germani MD, Paolo Brunori MD, Maria Teresa Brentegani MT, Guglielmo Minniti MD, Calcedonio Calcara MD, Antonio Morelli MD & Italo Vantini MD

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  1. Giuseppe Chiarioni MD
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  2. Gabrio Bassotti MD, PhD
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  3. Ugo Germani MD
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  4. Paolo Brunori MD
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  6. Guglielmo Minniti MD
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  7. Calcedonio Calcara MD
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  8. Antonio Morelli MD
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  9. Italo Vantini MD
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Chiarioni, G., Bassotti, G., Germani, U. et al. Idiopathic megarectum in adults. Digest Dis Sci 40, 2286–2292 (1995). https://doi.org/10.1007/BF02209019

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  • DOI: https://doi.org/10.1007/BF02209019

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