title: The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography.
abstract: OBJECTIVE
  The sigmoidorectal junction (SRJ) has been defined as an anatomical sphincter with particular physiological behavior that regulates sigmoid and rectum evacuation. Its function in clinical conditions, such as diverticular disease has been advocated. The aim of our study is to identify the SRJ and to compare the morphometric and dynamic features of the SRJ between patients with diverticular disease and healthy subjects using MR-defecography.
  
  
  METHODS
  Sixteen individuals, eight with uncomplicated diverticular disease and eight healthy subjects, were studied using MR-defecography to identify the SRJ and to compare the morphometric and dynamic features observed.
  
  
  RESULTS
  In each subject studied, MR-defecography was able to identify the SRJ. This resulted in the identification of a discrete anatomical entity with a mean length of 31.23 mm, located in front of the first sacral vertebra (S1) and at a mean distance of 15.55 cm from the anal verge, with a mean wall thickness of 4.45 mm, significantly different from the sigmoid and rectal parietal thickness. The SRJ wall was significantly thicker in patients with diverticular disease than the controls (P = 0.005), showing a unique shape and behavior in dynamic sequences.
  
  
  CONCLUSIONS
  Our findings support the hypothesis that SRJ plays a critical role in patients with symptomatic diverticular disease; further investigation may clarify whether specific SRJ analysis, such as MR-defecography, would predict inflammatory complications of this diffuse and heterogenic disease.
authors.affiliation: DEAII, Emergency Department, Umberto I Policlinico di Roma, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy, framagnoli@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Romagnoli
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Colaiacomo
authors.forename: Ritanna
authors.initials: R
authors.lastname: De Milito
authors.forename: Claudio
authors.initials: C
authors.lastname: Modini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gualdi
authors.forename: Marco
authors.initials: M
authors.lastname: Catani
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D012809:Colon, Sigmoid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019841:Defecography / Q000379:methods; D043963:Diverticulosis, Colonic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000000981:diagnostic imaging* / Q000503:physiopathology