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Iatrogenic colorectal perforation induced by anorectal manometry:Report of two cases after restorative proctectomy for distal rectal cancer

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World Journal of Gastroenterology 2007年第45期13卷 6112-6114页

作者： Jun-Seok Park Sung-Bum Kang Duck-Woo Kim Na-Young Kim Kyoung-Ho Lee Young-Hoon Kim Department of Surgery Chung-Ang University Hospital Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do 463-707 Korea Department of Surgery Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do 463-707 Korea Department of Internal Medicine Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do 463-707 Korea Department of Diagnostic Radiology Seoul National University Bundang Hospital

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.

关键词： Iatrogenic perforation anorectal manometry Rectal cancer Low anterior resection

Effect of Modified Sinisan (四逆散) on anorectal manometry of the Constipation Predominant Type of Irritable Bowel Syndrome

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Chinese Journal of Integrated Traditional and Western Medicine 2005年第1期11卷 27-30页

作者：余苏萍叶辉哈楠林丁曙晴陈高 anorectal Department Nanjing Municipal TCM Hospital Nanjing (210001)

Objective: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (四逆散, SNS). Methods: Forty -seven IBS patients with the constipation predominant type were randomly divided into the treated group ( n =24) and the control group ( n =23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. Results: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment ( P <0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups ( P <0.05), and the improvement of the treated group was more significant than that of the control group( P <0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly ( P <0.05, P <0.01).Conclusion: SNS has good effect on IBS of the constipation predominant type.

关键词： irritable bowel syndrome constipation-predominant type anorectal manometry Sinisan

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先天性巨结肠根治术远期排便功能及测压检查

中华小儿外科杂志 1984年第2期5卷 88-90页

作者：王夫李正王慧贞康恩光中国医科大学附属第三医院小儿外科

Long-term post-operative clinical results and monometric measurements of 44 cases of Hirchsprung's disease are reported. They were carried out 1-9 years after radical resections. The patients aged from 3 to 17(the mean age was 7.5).The operations included Swenson's modification(37 cases),partial anorectal myectomy(5 cases)and Duhamel and Martin operations were employed in ahotner two cases respectively. 59.1% of the patients suffered from complications, including fecal soiling(40%),incontinence during diarrhea and urination (33.3%)constipation(16.7%) and urinary symptoms such as enuresis and micturition (10%). The pressure in the anal canal at rest can demonstrate the function of the internal analsphincter, I.e. higher pressure may produce constipation and lower pressure is likely to cause soiling or incontinence. Examinations showed that impaired function of the anal sphincter is the main cause of soiling and may also involve external sphincter. Therefore, anorectal manometry is one of the objective criterion to assess the defecation function.

关键词：先天性巨结肠根治术远期排便功能直肠肛管测压临床检查 Children anorectal manometry function anal sphincter anal canal 根治术后肛门 results 内压力肌功能 during 诊断患儿 rest main

Manometric Comparison of anorectal Function after Posterior Vaginal Compartment Repair with and without Mesh

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Chinese Medical Journal 2015年第4期128卷 438-442页

作者： Shuo Liang Lan Zhu Lei Zhang Zhi-Jing Sun Xu Tao Jing-He Lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical SciencesBeijing 100730 China Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences and School of Basic MedicinePeking Union Medical College Beijing 100730 China

Background：Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction,the data about posterior compartment are *** aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse （POP）.Methods：This was a prospective,double-blind,clinical pilot study of 22 postmenopausal women with symptomatic POP （overall POP-quantification [POP-Q] Stage Ⅲ-ⅣV） who underwent total pelvic floor *** were grouped according to the use of mesh for posterior vaginal compartment repair：A mesh group and a nonmesh ***-Q stage,the pelvic floor impact questionnaire short form-7 （PFIQ-7） and anorectal manometry were evaluated before and 3 months after *** success was defined as POP-Q Stage Ⅱ or less.A t-test was used to compare preoperative with postoperative data in the two ***：Totally,17 （71％） were available for the ***-Q measurements improved significantly compared to baseline （P ＜ 0.05） in both *** recurrence was *** in both groups reported improvement in pelvic floor symptoms,and there was no significant difference in the PFIQ-7 score between groups at follow-up （P ＞ 0.05）.Compared with baseline,the nonmesh group exhibited a statistically significant decrease in anal residual pressure,a significant increase in the anorectal pressure difference during bowel movement,and a reduced rate ofdyssynergia defecation pattern （P ＜ 0.05）.Conclusions：Provided there is sufficient support for the anterior wall and apex of vagina with mesh,posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

关键词： anorectal manometry Constipation Mesh Pelvic Organ Prolapse Posterior Vaginal Compartment Repair

anorectal functional outcome after repeated transanal endoscopic microsurgery

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World Journal of Gastroenterology 2012年第40期18卷 5807-5811页

作者： Hong-Wei Zhang Xiao-Dong Han Yu Wang Pin Zhang Zhi-Ming Jin Department of General Surgery the Sixth Peo-ple's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai 200233China

AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients

关键词： Familial adenomatous polyposis Repeatedtransanal endoscopic microsurgery anorectal function anorectal manometry Subtotal colectomy

anorectal functions in patients with lumbosacral spinal cord injury

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Chinese Journal of Traumatology 2006年第4期9卷 217-222页

作者：李文成肖传国 Neuroscience Center and Department of Urology Xiehe Hospital Tongji Medical College Neuroscience Center and Department of Urology Xiehe Hospital Tongji Medical CollegeHuazhong University of Science and Technology

To investigate the anorectal status in patients with lumbosacral spinal cord injury （SCI）. Methods： Twenty six patients （23 males, 3 females） with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years （ranging 17-68 years） and the median time of patients since injury was 59.1 months （ ranging 8 months-15 years）. They were diagnosed as complete lumbosacral SCI （n=2, American Spinal Injury Association （ASIA） score A）, or incomplete lumbosacral SCI （n =24, ASIA score B- D） with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study. Results： The maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group （ One-way ANOVA： P = 0. 939 ）. During defecatory maneuvers, 23 of 26 （ 88. 5 %） patients with lumbosacral SCI and I of 13 （ 7. 7 % ） in the control group showed pelvic floor dysfunction （PFD）（Fisher＇ s exact test： P〈0.0001）. Rectoanal inhibitory reflex （RAIR） was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group （Independent-Samples t test： P〈0.0001）. The mean rectal volume to generate the first sensation was 92.7 ml ± 57.1 mi in SCI patients, 41. S ml ± 13.4 ml in the control group （ Independent-Samples t test： P 〈0.0001 ）. Conclusions： Most of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectai manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system （CNS）.

关键词： Spinal cord injuries Central nervous system anorectal manometry