The Accuracy of Clinical Examination in the Diagnosis of Rectal Intussusception

Karlbom, Urban; Graf, Wilhelm; Nilsson, Sven Erik G.; Påhlman, Lars

doi:10.1007/s10350-004-0626-8

Cited by 34 publications

(24 citation statements)

References 20 publications

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“…The definition of intussusception was reported and/or referenced in a total of 40/63 (63%) studies. Among these, three main grading systems were used to define the severity of intussusception, originally described as “unilateral or circumferential infolding of the rectum during straining.” A total of seven studies adopted the classification proposed by Shorvon et al, which identifies seven degrees of intussusception, with grades 1‐4 inclusive being intra‐rectal (1 and 2: <3 mm; unilateral or circumferential, respectively; 3 and 4: >3 mm; unilateral or circumferential, respectively), 5 and 6 intra‐anal (the leading edge of the infolding impinges onto or into the anal canal, respectively), and 7 representing an external rectal prolapse.…”

Section: Summary Of Search Results and Study Qualitymentioning

confidence: 99%

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

Grossi

Tanna

Heinrich

et al. 2018

Aliment Pharmacol Ther

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Summary Background Defecography is considered the reference standard for the assessment of pelvic floor anatomy and function in patients with a refractory evacuation disorder. However, the overlap of radiologically significant findings seen in patients with chronic constipation (CC) and healthy volunteers is poorly defined. Aim To systematically review rates of structural and functional abnormalities diagnosed by barium defecography and/or magnetic resonance imaging defecography (MRID) in patients with symptoms of CC and in healthy volunteers. Methods Electronic searches of major databases were performed without date restrictions. Results From a total of 1760 records identified, 175 full‐text articles were assessed for eligibility. 63 studies were included providing data on outcomes of 7519 barium defecographies and 668 MRIDs in patients with CC, and 225 barium defecographies and 50 MRIDs in healthy volunteers. Pathological high‐grade (Oxford III and IV) intussuscepta and large (>4 cm) rectoceles were diagnosed in 23.7% (95% CI: 16.8‐31.4) and 15.9% (10.4‐22.2) of patients, respectively. Enterocele and perineal descent were observed in 16.8% (12.7‐21.4) and 44.4% (36.2‐52.7) of patients, respectively. Barium defecography detected more intussuscepta than MRID (OR: 1.52 [1.12‐2.14]; P = 0.009]). Normative data for both barium defecography and MRID structural and functional parameters were limited, particularly for MRID (only one eligible study). Conclusions Pathological structural abnormalities, as well as functional abnormalities, are common in patients with chronic constipation. Since structural abnormalities cannot be evaluated using nonimaging test modalities (balloon expulsion and anorectal manometry), defecography should be considered the first‐line diagnostic test if resources allow.

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Section: Summary Of Search Results and Study Qualitymentioning

confidence: 99%

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

Grossi

Tanna

Heinrich

et al. 2018

Aliment Pharmacol Ther

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“…Alternatively, chronic IRP can present with faecal incontinence (FI) . It has been postulated that FI associated with IRP is caused by occult defects of the external anal sphincter, traction pudendal neuropathy resulting from repeated excessive straining and distension of the lower rectum by the intussusceptum activating the rectoanal inhibitory reflex and inducing relaxation of the internal anal sphincter causing overflow incontinence .…”

Section: Introductionmentioning

confidence: 99%

Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta‐analysis

et al. 2017

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Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.

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“…If this relaxation is absent, the examiner should suspect dyssynergic defecation [11]. A recent cross-sectional study in 127 subjects with functional constipation showed that routine clinical examination can diagnose approximately half of patients with anorectal intussusception and most of the longer intussusceptions (>3 cm) seen at defecography [15]. Although digital rectal examination is an inexpensive and useful clinical tool, knowledge about how to perform a comprehensive evaluation is lacking.…”

Section: Physical Examination and Routine Blood Testsmentioning

confidence: 99%

Diagnostic testing in patients with chronic constipation

Troche¹,

Rao

2006

Curr Gastroenterol Rep

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During the past few years, significant developments have taken place in the understanding and diagnosis of defecation disorders. Several innovative manometric, neurophysiologic, and radiologic techniques have been discovered, which have improved the accuracy of identifying the neuromuscular and pathophysiologic mechanisms of chronic constipation. Such approaches have led to improved management of these patients. In this review, we summarize and highlight recent advances in the utility of diagnostic testing of chronic constipation.

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The Accuracy of Clinical Examination in the Diagnosis of Rectal Intussusception

Cited by 34 publications

References 20 publications

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation

Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta‐analysis

Diagnostic testing in patients with chronic constipation

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