Pseudodiverticular defecographic image after STARR procedure for outlet obstruction syndrome

Abstract

Outlet obstruction syndrome (OOS) is a defecation disorder more common in women. Patients refer to coloproctologists complaining of constipation and other typical symptoms ranging from incomplete and fragmentized evacuation to rectal bleeding. This syndrome may be caused by functional and/or anatomical alterations. A correct etiological classification can help the clinician to predict the best treatment strategy. Non-operative treatment, mainly based on dietary changes and biofeedback, is usually suggested as the first or unique treatment option when symptoms are caused by an uncoordinated inhibitory muscular pattern. Conversely, patients not responsive to conservative treatment most likely can benefit from surgery. Nevertheless, traditional techniques, aimed at restoring normal anatomy, are often time-consuming, technically demanding, burdened by serious complications, and, sometimes, under particular circumstances, can be ineffective or can even worsen symptoms. In 2003 Stapled Transanal Rectal Resection (STARR) was described by Longo as an effective new option for the cure of OOS. Since its introduction, STARR has become an accepted surgical procedure even if some criticisms have been raised due to possible serious complications. Recently, a case of rectal diverticulum after STARR procedure has been reported. Here, we describe a similar case, its related diagnostic and treatment modalities

Iatrogenic Rectal Diverticulum After Stapled Transanal Rectal Resection

“…Therefore, complications including dehiscence, perforations, diverticulum or rectal wall exclusion could happen in the weakness area [14]. Frascio F, et al, proposed that diverticulum can be due to an in-complete section of the mucosal band [13]. Nevertheless, in our patient, the anastomotic ring was performed with a fullthickness manual suture and any "posterior staple bridge" was divided with scissors.…”

“…Some predisposing factors include congenital defects, constipation, recurring impaction, relaxed rectovaginal septum, infections, ulcerations and rectal trauma leading to weakening of the rectal wall [8][9][10][11]. Recently, the occasional development of iatrogenic rectal diverticulum following STARR procedure has been described by sporadic reports [12,13].…”