Abstract
Twelve patients were studied for a median of 18 hours (range 8.5–21.5 hr) by continuous, ambulatory, simultaneous pouch and anal manometry 10–85 months after restorative proctocolectomy. Two main patterns of motility were observed: (1) Large isolated contractions up to 68 cm H2O in amplitude and up to 67 seconds in duration were present in ten patients. These were often associated with the urge to defaecate and were more frequent before defaecation than after but did not appear to be associated with expulsion of faeces from the pouch. In two patients atypical large isolated contractions up to 378 cm H2O in amplitude were observed. (2) Rhythmic contractions at a frequency of 7–11 per minute and amplitude of 24–330 cm H2O, occurred for a duration of 18 seconds to 18 minutes in six patients. In the other six patients this motility pattern was not seen. Of the 12 patients nine were considered to have good function (five or less bowel actions per 24 hours) and three poor function (ten or more bowel actions per 24 hours). Rhythmic activity was the predominant motility pattern in all three with poor function whereas large isolated contractions predominated in those with good function, although there was considerable overlap in the types of motility observed between patients with good and poor function. Mean pouch pressure tended to be higher in patients with poor function than in those with good function both throughout the entire recording and during sleep. In a number of patients simultaneous anal recordings revealed the presence of slow waves and falls in pressure, some of which were associated with a simultaneous rise in pouch pressure.
Résumé
Douze patients ayant subi une proctocolectomie avec confection d'un réservoir et d'une anastomose iléoanale ont été étudiés. 10–85 mois après l'intervention ils ont subi simultanément, ambulatoirement, et de manière continue durant 18 heures en moyenne (8.5–21,5 heures) une manométrie de la poche et du canal anal. Deux types principaux d'activité motrice ont été observés: (1) des contractions larges et isolées mesurant jusqu'à 68 cm d'H2O d'amplitude et durant jusqu'à 67 secondes étaient présentes chez 10 patients. Ces contractions étaient fréquemment associées avec des défécations impérieuses et étaient plus fréquentes avant qu'après défécation mais ne semblaient pas s'associer à l'expulsion du contenu fécal de la poche. Chez 2 patients, on a observé de larges contractions isolées atypiques mesurant jusqu'à 373 cm H2O d'amplitude. (2) Des contractions rythmiques d'une fréquence de 7–11/minute, d'une amplitude de 24–330 cm H2O et d'une durée de 18 secondes à 18 minutes ont été observés chez 6 patients. Ce type de contraction n'a pas été noté chez les 6 autres patients. Neuf des 12 patients ont été jugés comme ayant une bonne fonction (5 ou moins de 5 exonérations par 24 heures) et 3 comme ayant un résultat médiocre (10 et plus exonérations par 24 heures). Des contractions rythmiques constituent le mode prédominant d'activité motrice chez les 3 patients dont le résultat fonctionnel est médiocre alors que le larges contractions isolées prédominent chez les patients dont le résultat fonctionnel est bon, bien que les 2 types d'activité se chevauchent considérablement entre les 2 groupes de patients avec bon ou médiocre résultat fonctionnel. La pression moyenne est plus élevée durant tout l'enregistrement et durant le sommeil chez les patients dont le résultat fonctionnel est mauvais que chez ceux dont le résultat fonctionnel est bon. Chez un petit nombre de patients, l'enregistrement simultané des pressions du canal anal met en évidence des ondes lentes et des chutes de la pression survenant chez quelques uns simultanément à des hausses de la pression dans la poche.
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Levitt, M.D., Kamm, M.A., van der Sijp, J.R.M. et al. Ambulatory pouch and anal motility in patients with ileo-anal reservoirs. Int J Colorect Dis 9, 40–44 (1994). https://doi.org/10.1007/BF00304299
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DOI: https://doi.org/10.1007/BF00304299