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Citation:
Rahman T, Bell D, Shah V, Rectoanal intussusception. Reference article, Radiopaedia.org (Accessed on 28 Apr 2024) https://doi.org/10.53347/rID-182665
Rectoanal intussusception refers to the telescoping or infolding of the rectal wall within the rectum itself, or into the anal canal, or externally, during defecation.
Rectoanal intussusception is also termed internal intussusception and internal procidentia1 .
Rectoanal intussusception is present in 12-31% of patients with obstructed defecation syndrome 2 .
The gold standard for diagnosis of rectoanal intussusception is fluoroscopic evacuation proctography. When compared with MRI defecating proctography, intussusception was observed at a higher frequency in fluoroscopic tests, partly related to the higher rate of rectal emptying on fluoroscopic studies versus MRI 23,24.
It is possible to diagnose rectoanal intussusception on digital rectal examination or with proctoscopy but it is not very helpful in case of short intussusceptions 6.
Rectoanal intussusception may be symptomatic or asymptomatic.
The presenting symptoms are:
The underlying etiology and pathophysiologic processes are not yet clear. In some instances, the intussusception is considered to be the primary abnormality, part of global pelvic floor failure, and associated with symptoms of obstructed defecation syndrome or fecal incontinence. In other cases, chronic straining due to other disorders such as constipation or a rectocele may lead to incidental mucosal intussusception.
The literature is varied in recommendations on how intussusception should be described. Conventionally, they are described in terms of the location they reach (rectal, anal or external) and whether they are mucosal or full thickness 22. The most recent consensus statement from a North American group suggested using the terms intrarectal, intra-anal or external 21.
Fluoroscopic defecography
telescoping of mucosa or full thickness of rectum into the low rectum, anal canal or beyond the anal verge during defecation
associated findings may include rectocele, sigmoidocele and enterocele
MR defecography
Treatment and prognosis
Non operative management
medical therapy 15
biofeedback therapy 16
Operative management
History and etymology
Allingham first described this condition in 1873 20 .
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1. Choi J, Hwang Y, Salum M et al. Outcome and Management of Patients with Large Rectoanal Intussusception. Am J Gastroenterology. 2001;96(3):740-4. doi:10.1111/j.1572-0241.2001.03615.x - Pubmed
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2. Agachan F, Pfeifer J, Wexner SD. Defecography and proctography.
Results of 744 patients. Dis Colon Rectum.
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3. Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal
intussusception, rectocele, solitary rectal ulcer syndrome, and
enterocele. Gastroenterol Clin North Am 2008;37(3):645–668,
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4. Palit S, Bhan C, Lunniss PJ, et al. Evacuation proctography: a
reappraisal of normal variability. Colorectal Dis 2014;16(7):
538–546.
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5. Weiss EG, McLemore EC. Functional disorders: rectoanal intussusception. Clin Colon Rectal Surg 2008;21(2):122–128.
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6. Karlbom U, Graf W, Nilsson S, Påhlman L. The accuracy of clinical
examination in the diagnosis of rectal intussusception. Dis Colon
Rectum 2004;47(9):1533–1538.
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7. Vitton V, Vignally P, Barthet M, et al. Dynamic anal endosonography and MRI defecography in diagnosis of pelvic floor disorders:comparison with conventional defecography. Dis Colon Rectum2011;54(11):1398–1404.
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8. Thapar RB, Patankar RV, Kamat RD, Thapar RR, Chemburkar V. MR
defecography for obstructed defecation syndrome. Indian J Radiol
Imaging 2015;25(1):25–30
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9. Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal
intussusception, rectocele, solitary rectal ulcer syndrome, and
enterocele. Gastroenterol Clin North Am 2008;37(3):645–668
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10. Hwang Y H, Person B, Choi J S, et al. Biofeedback therapy for rectal intussusception. Tech Coloproctol. 2006;10:11–16.
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11. Fleshman J W, Kodner I J, Fry R D. Internal intussusception of the rectum: a changing perspective. Neth J Surg. 1989;41:145–148.
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12. Christiansen J, Zhu B W, Rasmussen O O, Sorensen M. Internal rectal intussusception: results of surgical repair. Dis Colon Rectum. 1992;35:1026–1029.
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13. Jorge J MN, Habr-Gama A, Wexner S D. Clinical applications and techniques of cinedefecography. Am J Surg. 2001;182:93–101.
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14. Matsuoka H, Wexner S D, Desai M B, et al. A comparison between dynamic pelvic magnetic resonance imaging and videoproctography in patients with constipation. Dis Colon Rectum. 2001;44:571–576.
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15. Hoffman M J, Kodner I J, Fry R D. Internal intussusception of the rectum: diagnosis and surgical management. Dis Colon Rectum. 1984;27:435–441.
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16. Hwang Y H, Person B, Choi J S, et al. Biofeedback therapy for rectal intussusception. Tech Coloproctol. 2006;10:11–16.
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17. Delorme E. Sur le traitement des prolapsus du rectum totaux pour l'excision de la muqueuse rectale ou recto colique. Bull Mem Soc Chir Paris. 1900;26:499–578.
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18. Graf W, Karlbom U, Pahlman L, Nilsson S, Ejerblad S. Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg. 1996;162:905–911.
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19. Longo A. Treatment of hemorrhoids disease by reduction of mucosal and hemorrhoidal prolapse with a circular suturing device: a new procedure. Rome, Italy: Paper presented at: 6th World Congress of Endoscopic Surgery; May 31–June 5, 1998.
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20. Hwang Y H, Person B, Choi J S, et al. Biofeedback therapy for rectal intussusception. Tech Coloproctol. 2006;10:11–16.
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21. Gurland B, Khatri G, Ram R et al. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR Am J Roentgenol. 2021;217(4):800-12. doi:10.2214/ajr.21.26488 - Pubmed
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22. Dimitriou N, Shah V, Stark D, Mathew R, Miller A, Yeung J. Defecating Disorders: A Common Cause of Constipation in Women. Womens Health (Lond Engl). 2015;11(4):485-500. doi:10.2217/whe.15.25
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23. Pilkington S, Nugent K, Brenner J et al. Barium Proctography vs Magnetic Resonance Proctography for Pelvic Floor Disorders: A Comparative Study. Colorectal Dis. 2012;14(10):1224-30. doi:10.1111/j.1463-1318.2012.02945.x - Pubmed
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24. Zafar A, Seretis C, Feretis M et al. Comparative Study of Magnetic Resonance Defaecography and Evacuation Proctography in the Evaluation of Obstructed Defaecation. Colorectal Dis. 2017;19(6):O204-9. doi:10.1111/codi.13657 - Pubmed
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