Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography?

Background Three-dimensional high-resolution anorectal manometry (3 DHRAM), used for exploring anorectal disorders, was recently developed, providing interesting topographic data for the diagnosis of pelvic floor disorders such as excessive perineal descent. The aim of our study was to define a diagnostic strategy based on selected 3 DHRAM parameters to identify rectal intussusceptions ( RI), considering conventional defecography ( CD) as the gold standard. Methods All patients referred to our center in the previous 6 months for 3 DHRAM to explore fecal incontinence or constipation, and who previously achieved CD, were eligible. 3 DHRAM results were obtained for all classical parameters and the presence of a narrow band of high pressure in the anal canal during attempted defecation, which was recently found to be associated with RI in some studies. The sensitivity, specificity, and positive and negative predictive values were calculated for various 3 DHRAM criterion in order to propose a diagnostic strategy for RI. Key Results Twenty-six patients (66%) presented with RI on CD. On 3 DHRAM, according to our diagnostic strategy, the most relevant manometric criterion for the diagnosis of RI was the association of an anterior additional high-pressure area and an excessive perineal descent, with a positive predictive value of 100% [81.5-100], a specificity of 100% [75.3-100] and a sensibility of 69.2% [48.2-85.7]. Conclusions & Inferences In this study, 3 DHRAM was used to diagnose RI, and we confirmed its use in the diagnosis of pelvic floor disorders. Further studies will be necessary to define classifications for these new anatomic data from 3 DHRAM. [ABSTRACT FROM AUTHOR]