title: Phantom rectum following abdominoperineal excision for rectal neoplasm: appearance and disappearance.
abstract: OBJECTIVE
  The sensation that the rectum remains or is functioning after abdominoperineal excision (APE) is called phantom rectum (PR). Its postoperative and long-term morbidity are not well documented. Informed consent may not include the risk and consequences of this condition. We assessed the incidence and morbidity of PR after APE and compared those with vs those without vertical rectus abdominis myocutaneous flaps.
  
  
  METHODS
  Patients who underwent APE between 1 January 2004 and 31 December 2008 were identified. Preoperative radiation and operative reconstruction by vertical rectus abdominis myocutaneous (VRAM) flaps were noted. Patients were interviewed by telephone to assess the presence and timing of PR symptoms and their effect on quality of life.
  
  
  RESULTS
  Thirty-six of 80 patients who underwent APE were available for follow-up. Twenty-three (64%) described PR symptoms including urgency to evacuate [22 (61%)], sensation of faeces in the rectum [19 (52%)] and sensation of passing flatus [17 (48%)]. Eleven (47%) who had VRAM vs 25 who did not, reported having symptoms of PR at < 3 months after APE. Patients described their symptoms as 'unchanged over time' [20 (56%)], 'gradually decreasing and ultimately disappearing' [13 (35%)] or 'worsening' [3 (9%)]. Preoperative radiation and laparoscopic approach were not associated with PR symptoms. Significantly more patients having a VRAM flap reported early PR symptoms [7/11 (64%) vs 4/25 (16%)] (P = 0.008).
  
  
  CONCLUSIONS
  PR sensations were experienced by 23 (64%) patients who underwent APE for rectal cancer. VRAM reconstruction was associated with early PR presentation. The possibility of PR should be discussed preoperatively in patients undergoing APE for anorectal neoplasm.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: C
authors.initials: C
authors.lastname: Reategui
authors.forename: F F
authors.initials: FF
authors.lastname: Chiang
authors.forename: L
authors.initials: L
authors.lastname: Rosen
authors.forename: D
authors.initials: D
authors.lastname: Sands
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D064827:Myocutaneous Flap / Q000009:adverse effects*; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D017568:Rectus Abdominis / Q000637:transplantation; D012678:Sensation Disorders / Q000209:etiology*; D013997:Time Factors
keywords: Phantom rectum; abdominoperineal excision; anal reconstruction; anorectal neoplasia; myocutaneous flap; rectal sensation