Physiological and structural anorectal abnormalities in patients with systemic sclerosis and fecal incontinence

Franck-Larsson, Karin; Graf, Wilhelm; Eeg‐Olofsson, Karin Edebol; Axelson, Hans; Rönnblom, Anders

doi:10.3109/00365521.2014.913188

Cited by 12 publications

(5 citation statements)

References 39 publications

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“…Centromeric antibodies and in particular vascular disease have been identified as possible risk factors for anal incontinence among SSc patients [13]. It is unclear whether ischemic events are responsible for the nerve damage or not [14]. …”

Section: Discussionmentioning

confidence: 99%

Stubborn rectal prolapse in systemic sclerosis

Petersen¹,

Tobisch²,

Puhl³

et al. 2017

Reumatologia

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Systemic sclerosis (SSc) is an autoimmune connective tissue disorder. Anorectal involvement might typically cause fecal incontinence and rarely rectal prolapse. Here we report three female patients, who were admitted with a mean history of 10 years suffering from SSc. All patients presented with the initial symptom of anal incontinence, in all cases this was associated with rectal intussusception or rectal prolapse. The three women faced prolapse recurrence, independent of the initial procedure. After surgical removal of the prolapse, the incontinence remained.In SSc rectal prolapse syndrome might occur at an earlier age, and a primary prolapse of the ventral aspect of the rectal wall seems to be typical for this disease. If patients with prior diagnosis of SSc appear with third degree of fecal incontinence, it is suspected to be associated with rectal prolapse. The prolapse recurrence rate after surgery in SSc patients is high.

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Section: Discussionmentioning

confidence: 99%

Stubborn rectal prolapse in systemic sclerosis

Petersen¹,

Tobisch²,

Puhl³

et al. 2017

Reumatologia

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“…Internal anal sphincter atrophy was present in SSc patients with incontinence but absent in control patients with incontinence, where the external anal sphincter predominantly was more affected (11, 81). In addition, imaging modalities have consistently found atrophy of the internal anal sphincter in SSc patients (11, 76, 77, 81).…”

Section: Colon and Anorectummentioning

confidence: 99%

“…Imaging studies are employed when there is a need to evaluate for mechanical obstruction. In those SSc patients where functional anorectal problems are suspected, anorectal manometry with pudendal nerve latency testing is the confirmatory test, and characteristic findings in SSc include lower anal sphincter resting and squeezing pressures and diminished or absent rectoanal inhibitory reflex (76–77–78–79–80). Anorectal ultrasound or pelvic MRI can be used to further assess the soft tissue structures, but these tests are not routinely indicated.…”

Section: Colon and Anorectummentioning

confidence: 99%

Gastrointestinal manifestations of systemic sclerosis

Shreiner

Murray

Denton

et al. 2016

Journal of Scleroderma and Related Disorders

119

105

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In patients with systemic sclerosis (SSc), gastrointestinal (GI) tract involvement is almost universal. Any segment of the GI tract from mouth to anus can be involved, and GI symptoms are a frequent cause of morbidity. In severe cases, GI tract involvement can progress to the point of malnutrition requiring parenteral nutrition. GI tract involvement in SSc contributes to disease-related mortality although mostly as a co-morbidity rather than direct cause of death. The review is intended to help address challenges in the assessment and treatment of GI tract involvement in SSc.

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“…In addition, vascular disease and neuropathy leading to abnormalities in external and internal anal sphincters have been proposed as possible mechanism for fecal incontinence in those patients. 7,[10][11][12][13]18 Permanent stoma is a surgical solution to a variety of medical conditions including fecal incontinence, severe perianal disease, obstructive defecation syndrome, and tumors of the low rectum. Although stoma have effect on self-body image, it is still far better than full loss of fecal continence and prolapse recurrence.…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

“…In addition, vascular disease and neuropathy leading to abnormalities in external and internal anal sphincters have been proposed as possible mechanisms in this process. 7,[9][10][11][12][13] Although rectal prolapse is a well-known manifestation in SSc patients, only a few cases have previously been described. Those published cases have demonstrated high recurrence rate after any kind of restorative surgery, compared to the non-SSc rectal prolapse patients.…”

Section: Introductionmentioning

confidence: 99%

High Failure Rate Following Restorative Surgery for Rectal Prolapse in Systemic Sclerosis Patients

Kahana

Freund

Koslowsky

et al. 2021

The American Surgeon™

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Introduction Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder. Colonic disorders are reported in 70% of patients. Only a few cases of rectal prolapse surgical repair in SSc patients were published, demonstrating high recurrence rate following any restorative surgery. The aim of this study is to present our surgical experience combined with the reported cases of SSc patients who underwent surgical interventions for rectal prolapse. Methods We reviewed our data and the published reports in the English literature of patients with SSc who underwent surgery for rectal prolapse. We located 6 case reports, in addition to 3 patients who were operated in our center. Results A total of 19 procedures (9 patients) were included, among them 17 restorative surgeries and 2 low anterior resections (LAR) with end-colostomy. All patients were female (mean age 70.3). Index surgery was perineal rectosigmoidectomy in 5, abdominal resection rectopexy in 3, and LAR with colostomy in 1 patient. All patients following restorative surgery suffered from fecal incontinence. 5 patients (62.5%) who underwent restorative surgery required at least 1 re-operation. The 2 patients who underwent LAR and colostomy reported a complete resolution of anorectal symptoms with a major improvement in their quality of life. Conclusion High recurrence rate is expected in SSc patients with rectal prolapse who undergo a restorative procedure. Low anterior resection and permanent colostomy provide an alternative surgical option to patients with SSc and prolapse in contrast to restorative surgery. We believe that this surgical approach should be offered for these patients.

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Physiological and structural anorectal abnormalities in patients with systemic sclerosis and fecal incontinence

Cited by 12 publications

References 39 publications

Stubborn rectal prolapse in systemic sclerosis

Stubborn rectal prolapse in systemic sclerosis

Gastrointestinal manifestations of systemic sclerosis

High Failure Rate Following Restorative Surgery for Rectal Prolapse in Systemic Sclerosis Patients

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