title: Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography?
abstract: BACKGROUND
  Three-dimensional high-resolution anorectal manometry (3DHRAM), 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 3DHRAM 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 3DHRAM to explore fecal incontinence or constipation, and who previously achieved CD, were eligible. 3DHRAM 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 3DHRAM criterion in order to propose a diagnostic strategy for RI.
  
  
  RESULTS
  Twenty-six patients (66%) presented with RI on CD. On 3DHRAM, 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
  In this study, 3DHRAM 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 3DHRAM.
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.|Plateforme d'interface clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Benezech
authors.affiliation: Service de Gastroentérologie, Centre Hospitalier Général de Martigues, Martigues, France.
authors.forename: M
authors.initials: M
authors.lastname: Cappiello
authors.affiliation: Unité d'Aide Méthodologique à la Recherche Clinique, EA 3279, Laboratoire de Santé Publique, Aix-Marseille Université, Marseille, France.
authors.forename: K
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.|Plateforme d'interface clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Grimaud
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.|Plateforme d'interface clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Bouvier
authors.affiliation: Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.|Plateforme d'interface clinique, CRN2M CNRS UMR 7286, Aix-Marseille Université, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vitton
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003248:Constipation / Q000000981:diagnostic imaging / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D019841:Defecography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007443:Intussusception / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies
keywords: anorectal manometry; constipation; defecography; fecal incontinence; rectal intussusception