Abstract
The mechanism of rectal motility has remained largely obscure. Recently, by recording rectal electromechanical activity, we identified the rectal motility pattern as occurring in a "mass squeeze" manner. In the current communication, rectal motility was studied by means of videodefecography. The study comprised 28 healthy volunteers (18 men, 10 women; mean age 37.6±11.8 years). Evacuation dynamics were studied and registered using a videocassette tape with a high-resolution recorder. The rectum showed no peristaltic or segmentation activity at rest. When the subject was asked to evacuate, a contraction wave started at the rectosigmoid junction (RSJ) and spread aborally. The upper rectum appeared to contract producing anal canal opening and the closure of the RSJ; after rectal evacuation, the anal canal closed and the RSJ opened. The rectal contraction wave was repeated as long as the rectum still contained barium paste. The subjects strained prior to the start of each contraction wave. Some waves did not effect rectal evacuation. These "incomplete" waves started at the mid- or lower rectum and were followed by "complete" waves that produced evacuation. In five of 28 subjects, rectal intussusception occurred during rectal contraction. A small anterior rectocele occurred in another two subjects during rectal contraction. Videodefecography revealed that upon rectal distension with barium paste, a contraction wave, initiated at the RSJ, effected reflex RSJ closure and anal canal opening. The wave spread aborally, "squeezing" the rectal contents towards the opened anal canal. Two types of contraction waves were observed: "complete" which produced rectal evacuation, and "incomplete" which failed to effect evacuation. Physiologic intussusception or rectocele were seen in a few subjects.
Résumé
Le mécanisme de la motilité rectale est resté largement obscur. Récemment, en enregistrant l'activité électro-mécanique du rectum, nous avons identifié la configuration de la motilité rectale telle qu'elle survenait lors d'une compression en masse. Dans le présent travail, la motilité rectale a été étudiée au moyen de la vidéodéfécographie. L'étude a intéressé 28 volontaires sains (18 hommes et 10 femmes, âgés en moyenne de 37,6±11,8 ans). Les courbes dynamiques d'évacuation ont été étudiées et enregistrées en utilisant des vidéocassettes avec un enregistreur à haute résolution. Le rectum ne présentait au repos aucune activité péristaltique ou de segmentation. Quand on demandait au sujet d'évacuer, une onde de contraction débutait à la jonction recto-sigmoïdienne et diffusait caudalement. La partie supérieure du rectum semblait se contracter, produisant une ouverture du canal anal et une fermeture de la jonction recto-sigmoïdienne; après évacuation rectale, le canal anal se fermait et la jonction recto-sigmoïdienne s'ouvrait. L'onde de contraction rectale se répétait aussi longtemps que le rectum contenait encore de la pâte barytée. Les sujets forçaient avant le début de chaque vague de contraction. Quelques vagues n'entraînaient pas d'évacuation rectale. Ces vagues "incomplètes" commençaient à la partie moyenne ou basse du rectum et étaient suivies par des vagues complètes qui produisaient réellement l'évacuation. Sur 5 sujets sur 28, une invagination survenait au cours de la contraction rectale. Une petite rectocèle antérieure survenait chez deux autres sujets au cours de la contraction rectale. La vidéodéfécographie a montré que, sous distension rectale par une pâte barytée, une onde de contraction, née à la jonction recto-sigmoïdienne, entraînait une fermeture réflexe de la jonction recto-sigmoïdienne et une ouverture du canal anal. La vague diffusait en direction caudale, poussant le contenu rectal vers le canal anal ouvert. Deux types d'ondes de contraction ont été observés: complètes, produisant une évacuation rectale, et incomplètes, qui ne parvenaient pas à obtenir une évacuation. Une invagination physiologique ou une rectocèle ont été vues chez quelques sujets.
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Waltraut Reichelt and Margot Yehia assisted in preparing the manuscript.
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Shafik, A., Shafik, A.A., El-Sibai, O. et al. Videodefecography: a study of the rectal motile pattern. Surg Radiol Anat 25, 139–144 (2003). https://doi.org/10.1007/s00276-003-0114-1
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DOI: https://doi.org/10.1007/s00276-003-0114-1