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Journal of the Korean Society of Coloproctology 2005;21(6):362-369.
The Clinical and Physiologic Characteristics of Patients with Pelvic Outlet Obstructive Disease.
Ahn, Eun Jung , Jeong, Gyu Young , Cheon, Seung Hui , Lee, Eun Joung , Oh, Soo Youn , Chung, Soon Sup , Lee, Ryung Ah , Kim, Kwang Ho , Park, Eung Bum
1Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea. gs3945@dreamwiz.com
2Department of Surgery, Konkuk University College of Medicine, Cheongju, Korea.
Abstract
PURPOSE
With recent anorectal physiologic studies, functional etiologies of pelvic outlet obstructive disease were evaluated in detail. The current study was designed to assess the clinical and the physiologic characteristics of patients with pelvic outlet obstructive disease.
METHODS
one hundred two (102) patients with pelvic outlet obstructive disease were evaluated with anorectal physiologic studies, including the colonic transit time (n=66), anorectal manometry (n=88), defecography (n=102), anal sphincter EMG (n=50), and colonoscopy or barium enema (n=77). The patients were categorized as group I (nonrelaxing puborectalis syndrome), group II (rectocele), group III (sigmoidocele), and group IV (rectoanal intussusception). The clinical and the physiologic characteristics were compared between the groups.
RESULTS
The mean age was 51.9 years, and the sex ratio was 1:1.9. the populations of the groups were group I 45.1% (n=46), group II 36.3% (n=37), group III 5.9% (n=6), and group IV 9.8% (n=10). In group II and group III, co-existing etiologies were more, and the incidences of female patients was higher (P<0.05). Delayed colonic transit time was noted in 11 patients (17%). Diverticula was observed in 6 patients (8%), polyps in 12 patients (16%), and melanosis coli in 14 patients (18%). On anorectal manometry, group I showed higher maximal voluntary contraction and mean squeezing pressure than the other groups (P<0.05). On defecography, group I had a shorter perineal descent at rest and a smaller anorectal angle at push (P<0.05).
CONCLUSIONS
The current study showed the clinical and the physiologic characteristics of the each functional etiology in patients with pelvic outlet obstructive disease. These results provide fundamental data for diagnosis of and tailored therapy for pelvic outlet obstructive disease.
Key Words: Pelvic outlet obstructive disease; Nonrelaxing puborectalis syndrome; Rectocele; Sigmoidocele; Rectoanal intussusception


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