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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 5/2007

01-05-2007

A Novel Technique to Identify Patients with Megarectum

Authors: Marc A. Gladman, Ph.D., M.R.C.O.G., M.R.C.S.(Engl.), Lee S. Dvorkin, M.D., M.R.C.S., S. Mark Scott, Ph.D., Peter J. Lunniss, M.S., F.R.C.S., Norman S. Williams, M.S., F.R.C.S., F.Med.Sci.

Published in: Diseases of the Colon & Rectum | Issue 5/2007

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Purpose

Traditional methods of identifying patients with persistent dilation of the rectum, or megarectum, are associated with inherent methodologic limitations. The purpose of this study was to use a barostat to establish criteria for the diagnosis of megarectum and to assess rectal diameter during isobaric (barostat) and volumetric (barium contrast) distention protocols in constipated patients with megarectum on anorectal manometry.

Methods

During fluoroscopic screening, rectal diameter was measured at minimum distending pressure of the rectum, achieved using a barostat. It was also measured during evacuation proctography (volumetric distention). Having established a normal range in 25 healthy volunteers, 30 constipated patients with evidence of megarectum on anorectal manometry (elevated maximum tolerable volume on latex balloon distention) were studied. A further 10 constipated patients without evidence of megarectum were studied (normal rectum).

Results

Megarectum was diagnosed when the rectal diameter was greater than 6.3 cm at minimum distending pressure. Rectal diameter at minimum distending pressure was increased in 20 patients (67 percent) with megarectum on anorectal manometry, but was normal in the remaining 10 patients (33 percent) and all patients with a normal rectum on anorectal manometry. Rectal diameter was increased at evacuation proctography in only 15 patients (50 percent) with evidence of megarectum on anorectal manometry.

Conclusions

The prevalence of megarectum is overestimated and underestimated when rectal diameter is assessed using anorectal manometry and contrast studies, respectively. Controlled (pressure-based) distention combined with fluoroscopic imaging allowed accurate identification of patients with megarectum on the basis of a rectal diameter greater than 6.3 cm at the minimum distention pressure. Measurement of rectal diameter at minimum distention pressure may be useful in those patients with an elevated maximum tolerable volume on anorectal manometry when surgery is being contemplated.
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Metadata
Title
A Novel Technique to Identify Patients with Megarectum
Authors
Marc A. Gladman, Ph.D., M.R.C.O.G., M.R.C.S.(Engl.)
Lee S. Dvorkin, M.D., M.R.C.S.
S. Mark Scott, Ph.D.
Peter J. Lunniss, M.S., F.R.C.S.
Norman S. Williams, M.S., F.R.C.S., F.Med.Sci.
Publication date
01-05-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 5/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0805-x

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