BACKGROUND
Rectoanal intussusception may cause symptoms of obstructed defecation, and functional results of prosthesis rectopexy are usually not satisfactory. The aim of this study was to assess several parameters of the disorder and to evaluate the outcome of resection rectopexy.
METHODS
During a 10-year period, 27 female patients with symptomatic large rectoanal intussusception had resection rectopexy (23 laparoscopy; 4 laparotomy). Conservative treatment, including biofeedback treatment in 22 patients, had failed in all cases. Preoperative and postoperative evaluation included clinical assessment, anorectal manometry, evacuation defecography, and colon transit studies. Follow-up ranged between one and five years.
RESULTS
Length of intussusception was 2 to 4.9 cm and was significantly related to pelvic floor descent (P = 0.003) and inversely related to resting anal pressures (P < 0.001). Eleven patients had undergone a previous hysterectomy, 9 had enterocele-sigmoidocele, 7 had incontinence of varying severity, and 8 had a solitary rectal ulcer. Colon transit was abnormal in all but five cases. Immediate functional results were bad in two-thirds of the cases; tenesmus, urge to defecate, and frequent stools were the main complaints. By the time these symptoms had subsided, and one year after surgery, all but two patients were satisfied with the outcome. Intussusception was reduced in all cases, anal sphincter tone recovered (P = 0.002), perineal descent decreased (P < 0.001), and colonic transit was accelerated (P < 0.001). Patients available at five-year follow-up had no or only minor defecatory problems.
CONCLUSION
Resection rectopexy improves symptoms of obstructed defecation attributed to large rectoanal intussusception.
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REFERENCES
B Broden B Snellman (1968) ArticleTitleProcidentia of the rectum studied with cinematography: a contribution to the discussion of causative mechanism Dis Colon Rectum 11 330–47 Occurrence Handle5683626
WM Sun NW Read TC Donnelly et al. (1989) ArticleTitleA common pathophysiology for full thickness rectal prolapse, anterior rectal mucosal prolapse and solitary rectal ulcer Br J Surg 76 290–5 Occurrence Handle1:STN:280:BiaB2cfjs1c%3D Occurrence Handle2720327
T Ihre U Seligson (1975) ArticleTitleIntussusception of the rectum-internal procidentia: treatment and results in 90 patients Dis Colon Rectum 18 391–6 Occurrence Handle1:STN:280:CSqB3cfls1E%3D Occurrence Handle1149581
A Mellgren I Schultz C Johansson A Dolk (1997) ArticleTitleInternal rectal intussusception seldom develops into total rectal prolapse Dis Colon Rectum 40 817–20 Occurrence Handle1:STN:280:ByiA28vptFQ%3D Occurrence Handle9221859
JS Choi YH Hwang MR Salum et al. (2001) ArticleTitleOutcome and management of patients with large rectoanal intussusception Am J Gastroenterol 96 740–4 Occurrence Handle10.1111/j.1572-0241.2001.03615.x Occurrence Handle1:STN:280:DC%2BD3M7ovFOktA%3D%3D Occurrence Handle11280544
MRB Keighley P Shouler (1984) ArticleTitleClinical and manometric features of the solitary rectal ulcer syndrome Dis Colon Rectum 27 507–12 Occurrence Handle1:STN:280:BiuB1cvosVU%3D Occurrence Handle6468184
JW Fleshman IJ Kodner RD Fry (1989) ArticleTitleInternal intussusception of rectum: a changing perspective Neth J Surg 41 145–8 Occurrence Handle1:STN:280:By%2BC3sjktVc%3D Occurrence Handle2694021
HC Kuijpers RH Schreve HC Ten Cate Hoedemakers (1986) ArticleTitleDiagnosis of functional disorders of defecation causing solitary rectal ulcer syndrome Dis Colon Rectum 29 126–9 Occurrence Handle1:STN:280:BimC3cjmslE%3D Occurrence Handle3943422
J Dahl BL Lindquist C Tysk P Leissner L Philipson G Jarnerot (1991) ArticleTitleBehavioral medicine treatment in chronic constipation with paradoxical sphincter contraction Dis Colon Rectum 34 769–76 Occurrence Handle1:STN:280:By2D3cnpvVY%3D Occurrence Handle1914742
B Holmstrom G Broden A Dolk (1986) ArticleTitleResults of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia Dis Colon Rectum 29 845–8 Occurrence Handle1:STN:280:BiiD2sbpt10%3D Occurrence Handle3792166
RH Kruyt JB Delemarre HG Gooszen HJ Vogel (1990) ArticleTitleSelection of patients with internal intussusception of the rectum for posterior rectopexy Br J Surg 77 1183–4 Occurrence Handle1:STN:280:By6D38fmsFc%3D Occurrence Handle2224470
JL McCue JP Thompson (1990) ArticleTitleRectopexy for internal rectal intussusception Br J Surg 77 632–4 Occurrence Handle1:STN:280:By%2BA2crhtl0%3D Occurrence Handle2383728
WJ Orrom DC Bartolo R Miller et al. (1991) ArticleTitleRectopexy is an ineffective treatment for obstructed defecation Dis Colon Rectum 34 41–6 Occurrence Handle1:STN:280:By6C387ptl0%3D Occurrence Handle1991419
J Christiansen BW Zhu OO Rasmussen M Sorensen (1992) ArticleTitleInternal intussusception: results of surgical repair Dis Colon Rectum 35 1026–9 Occurrence Handle1:STN:280:ByyD2cfktl0%3D Occurrence Handle1425046
J Christiansen P Hesselfeldt M Sorensen (1995) ArticleTitleTreatment of internal rectal intussusception in patients with chronic constipation Scand J Gastroenterol 30 470–2 Occurrence Handle1:STN:280:ByqA28rns1E%3D Occurrence Handle7638574
WF Tets Van JH Kuijpers (1995) ArticleTitleInternal rectal intussusception-fact or fancy? Dis Colon Rectum 38 1080–3 Occurrence Handle7555423
W Graf U Karlbom L Pahlman et al. (1996) ArticleTitleFunctional results after abdominal suture rectopexy for rectal prolapse or intussusception Eur J Surg 162 905–11 Occurrence Handle1:STN:280:ByiC3MrlvFU%3D Occurrence Handle8956961
E Lazorthes R Gamagami R Cabarrot S Muhammad (1998) ArticleTitleIs rectal intussusception a cause of idiopathic fecal incontinence? Dis Colon Rectum 41 602–5 Occurrence Handle1:STN:280:DyaK1c3lsVSktw%3D%3D Occurrence Handle9593243
J Tsiaoussis E Chrysos M Glynos JS Vassilakis E Xynos (1998) ArticleTitlePathophysiology and treatment of the anterior mucosal prolapse syndrome Br J Surg 85 1699–702 Occurrence Handle10.1046/j.1365-2168.1998.00914.x Occurrence Handle1:STN:280:DyaK1M%2FptFejtA%3D%3D Occurrence Handle9876078
JR Thompson AH Chen PD Pettit MD Bridges (2002) ArticleTitleIncidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction Am J Obstet Gynecol 187 1494–500 Occurrence Handle12501052
RM Mollen JHC Kuijpers F Hoek van (2000) ArticleTitleEffects of rectal mobilization and lateral ligaments division on colonic and anorectal function Dis Colon Rectum 43 1283–7 Occurrence Handle1:STN:280:DC%2BD3cvltVGitg%3D%3D Occurrence Handle11005498
E Xynos E Chrysos J Tsiaoussis E Epanomeritakis JS Vassilakis (1999) ArticleTitleResection rectopexy for rectal prolapse. The laparoscopic approach Surg Endosc 13 862–4 Occurrence Handle1:STN:280:DyaK1MzotVKmsw%3D%3D Occurrence Handle10449839
GW Stevenson (1988) ArticleTitleProctography symposium Int J Colorectal Dis 3 67–89 Occurrence Handle3411186
PJ Shorvon S McHugh NE Diamant et al. (1989) ArticleTitleDefecography in normal volunteers: results and implications Gut 30 1737–49 Occurrence Handle1:STN:280:By%2BC38fktFU%3D Occurrence Handle2612988
RJ Nicholls JN Simson (1986) ArticleTitleAnteroposterior rectopexy in the treatment of solitary rectal ulcer syndrome without overt rectal prolapse Br J Surg 73 222–4 Occurrence Handle1:STN:280:BimC3s3ktFU%3D Occurrence Handle3947923
NR Womack NS Williams JH Holmfield Mist JF Morrison (1987) ArticleTitleAnorectal function in the solitary rectal ulcer syndrome Dis Colon Rectum 30 319–23 Occurrence Handle1:STN:280:BiiC1cbkvFY%3D Occurrence Handle3568919
HC Kuijpers G Bleijenberg (1985) ArticleTitleThe spastic pelvic floor syndrome: a cause of constipation Dis Colon Rectum 28 669–72 Occurrence Handle1:STN:280:BimD38botVI%3D Occurrence Handle4053909
P Luukkonen P Mikkonen H Jarvinen (1992) ArticleTitleAbdominal rectopexy with sigmoidectomy versus alone for rectal prolapse: a prospective, randomized study Intern J Colorectal Dis 7 219–22 Occurrence Handle1:STN:280:ByyC1cjkslE%3D
RF McKee JC Lauder FW Poon MA Aitchison IG Finlay (1992) ArticleTitleA prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse Surg Gynecol Obstet 174 145–8 Occurrence Handle1:STN:280:By2C3s3nvVw%3D Occurrence Handle1734574
C Johansson T Ihre SO Alback (1985) ArticleTitleDisturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia) Dis Colon Rectum 28 920–4 Occurrence Handle1:STN:280:BimD2MrhslM%3D Occurrence Handle4064851
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Tsiaoussis, J., Chrysos, E., Athanasakis, E. et al. Rectoanal Intussusception: Presentation of the Disorder and Late Results of Resection Rectopexy. Dis Colon Rectum 48, 838–844 (2005). https://doi.org/10.1007/s10350-004-0850-2
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DOI: https://doi.org/10.1007/s10350-004-0850-2