Colorectal Rupture: an Unusual Complication of Anorectal Manometry

Lee, Jung Yong; Park, Sang Hoon; Bak, Young Tae; Kim, Jin Ho; Moon, Hong Young

Abstract

Anorectal manometry is now widely performed to evaluate anorectal physiology in a variety of clinical conditions. No adverse consequence related with this procedure has been reported yet. There has been no known guideline or precaution regarding the upper limit of the volume inflating the rectal balloon in measuring maximum tolerable volume. We experienced 2 cases of colorectal rupture during measuring maximum tolerable volume. Both cases were in their early postoperative period, 1 month after low anterior resection due to rectal cancer and 3 months after Delorme's procedure due to rectal prolapse, respectively. The rectal sensory and anorectal motor responses to rectal distension are known to depend on the rate and pattern of distension. Therefore, results of different examiners and laboratories cannot be compared directly unless the pattern and rate of distension are the same. Wide intersubject and intrasubject variations in maximum tolerable volume have been also reported, and differentiation between patients and normal subjects is not necessarily possible. Measuring maximum tolerable volume is painful and unpleasant, and some authors believe that maximum tolerable volume in addition to the other steps of rectal sensations does not contribute any additional information. Based on our experience and literature, we suggest that measuring maximum tolerable volume might be better to be omitted, or if it be done, rectal balloon should be inflated with great care especially in early postoperative period or in those who cannot feel or express their symptoms clearly, such as elderly or infants.