title: Anterior intussusception descent during defecation is correlated with the severity of fecal incontinence in patients with rectoanal intussusception.
abstract: BACKGROUND
  Rectoanal intussusception (RAI) is a common finding on evacuation proctography in patients with defecation disorders. However, it remains unclear whether intussusception morphology affects the severity of fecal incontinence (FI). The aim of this study was to examine the effect of morphology during defecation on the severity of FI in patients with RAI.
  
  
  METHODS
  We included 80 patients with FI who were diagnosed as having RAI on evacuation proctography. Various morphological parameters were measured, and the level of RAI was divided by the extent of descent onto (level I) or into (level II) the anal sphincter. FI symptoms were documented using the FI Severity Index (FISI).
  
  
  RESULTS
  Twenty-eight patients had level I and 52 had level II RAI. The mean (range) FISI score was 24.0 (8-47). FISI scores tended to be significantly higher in level II than in level I [26.3 (10-47) vs. 21.8 (8-42); p = 0.05]. The mean anterior intussusception descent was significantly greater in level II than in level I [24.2 (9.2-39.5) vs. 17.7 (7.8-39.4) mm; p < 0.0001]. Regression analysis showed that anterior intussusception descent was predictive of increased FISI scores.
  
  
  CONCLUSIONS
  The severity of FI may be affected by anterior intussusception descent in patients with RAI.
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan. tsunoda.akira@kameda.jp.
authors.forename: A
authors.initials: A
authors.lastname: Tsunoda
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: W
authors.initials: W
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kiyasu
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kusanagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation; D019841:Defecography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications / Q000503:physiopathology*; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology; D012044:Regression Analysis; D012720:Severity of Illness Index
keywords: Evacuation proctography; Fecal incontinence; Morphology; Rectoanal intussusception