Reconstructive Surgery of the Rectum, Anus and Perineum by Andrew P. Zbar Robert D. Madoff & Steven Wexner

Author:Andrew P. Zbar, Robert D. Madoff & Steven Wexner
Language: eng
Format: epub
Publisher: Springer London, London

Subclassification of Patients with IMR on the Basis of Rectal Compliance: Anatomical and Physiological Dilatation

Excessive laxity (increased compliance) has been reported frequently in patients with IMR [37, 42, 43]. A recent barostat study has revealed that all patients with elevated rectal compliance had IMR [66], in keeping with the assumption that patients with increased rectal compliance have megarectum [57]. However, the converse was not true: an increased rectal diameter did not necessarily indicate elevated compliance because a proportion of patients with IMR had normal compliance [66]. That two subgroups of patients with IMR can be identified on the basis of rectal compliance raises the novel concept that these may differ pathophysiologically.

Those patients with increased rectal compliance might thus be described as having a “physiological megarectum,” in which gross rectal hyposensitivity (i.e., an absence of perception of rectal distension) allows chronic accumulation of feces and ultimately overdistension due to loss of rectal elasticity [66]. In the remainder, rectal compliance is normal, and such patients may be considered to have an “anatomical” megarectum [66]. Whether these subgroups represent different underlying etiologies is unknown at this time. Furthermore, it remains to be determined whether identification of these subgroups is relevant in clinical practice.

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