rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2015-0-5-57-71rentrad-82Research ArticleСтатьиСиндром опущения промежности у детей: патофизиология и диагностикаDescending perineum syndrome in children: Pathophysiology and diagnosisЛевинМ. Д.LevinM. D.

д. м. н., рентгенолог

MD, PhD, DSc, Radiologist

Республиканский детский хирургический центрБеларусьRepublican Children's Surgical CenterBelarus201509032016052735Copyright © Левин М.Д., 20162016Левин М.Д.Levin M.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/82

Цель исследования – предложить более безопасный, простой и точный метод диагностики синдрома опущения промежности.

Материал и методы

Материал и методы. Обследованы 194 больных в возрасте от 5 дней до 15 лет. Из них в 1-ю группу исследования включены 65 пациентов без патологии аноректальной зоны. Во 2-й группе было 129 больных: 66 детей с функциональным запором, 55 – с аноректальными аномалиями (АРА) и видимыми свищами, которые были обследованы до операции, а также 8 больных с АРА, обследованных после операции. Всем больным проведена ирригоскопия, которая отличалась от стандартного исследования наличием рентгеноконтрастного маркера около анального отверстия.

Результаты и заключение

Результаты и заключение. Синдром опущения промежности обусловлен повреждением функции пуборектальной мышцы. Предложен метод оценки состояния пуборектальной мышцы по расстоянию  аноректального угла от маркера около ануса. Это не только способствует более точной диагностике синдрома опущения промежности, но позволяет отказаться от дефекографии. Применение бариевой клизмы с выполнением минимального количества рентгенограмм резко уменьшает дозу ионизирующего облучения и позволяет применять этот способ не только у взрослых, но и у детей с хроническим запором, недержанием кала и при аноректальных аномалиях как до, так и после операции для оценки причин осложнений.

 

 

Objective

Objective: to propose a safer, simpler, and more exact method for the diagnosis of descending perineum syndrome (DPS).

Material and methods

Material and methods. A total of 194 patients aged 5 days to 15 years were examined and divided into 2 groups: Group 1 consisted of 65 patients without anorectal anomalies (AA); Group 2 comprised 129 patients, including 66 children with functional constipation,55 with AA and visible fistulas, who were preoperatively examined, and 8 patients with anorectal angle (ARA), who were postoperatively examined. All the patients underwentirrigoscopy that was different from standard examination in the presence of X-ray CT contrast marker near the anus. Results and conclusion. DPS is caused by puborectalis muscle dysfunction. A method was proposed to evaluate the status of the puborectalis muscle from the distance between the position of the ARA and the marker near the anus. This not only promotesan exacter estimate of DPS, but also allows refusal of defecography. The use of a barium enema with the minimum number of X-ray films decreases dose of ionizing radiation hazard and permits the use of this procedure not only in adults, but also in children with chronic constipation, fecal incontinence, and in AA for both pre- and postoperatively assessment of the causes of complications.

хронический запорнедержание калапуборектальная мышцасиндром опущения промежностидефекографияирригоскопияchronic constipationfecal incontinencepuborectalis muscledescending perineum syndromedefecographyirrigoscopyReferencesParks A.G., Porter N.H., Hardcastle J. The syndrome of the descending perineum. Proc. R. Soc. Med. 1966; 59 (6): 477–82. 34 5Parks A.G., Porter N.H., Hardcastle J. The syndrome of the descending perineum. Proc. R. Soc. Med. 1966; 59 (6): 477–82. 34 5Chang J., Chung S.S. An analysis of factors associated with increased perineal descent in women. J. Korean Soc. Coloproctol. 2012; 28 (4): 195–200.Chang J., Chung S.S. An analysis of factors associated with increased perineal descent in women. J. Korean Soc. Coloproctol. 2012; 28 (4): 195–200.Foti P.V., Farina R., Riva G., Coronella M. et al. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol. Med. 2013; 118 (1): 23–39.Foti P.V., Farina R., Riva G., Coronella M. et al. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol. Med. 2013; 118 (1): 23–39.Kumar S., Ramadan S., Gupta V. et al. Manometric tests of anorectal function in 90 healthy children: a clinical study from Kuwait. J. Pediatr. Surg. 2009; 44 (9): 1786–90.Kumar S., Ramadan S., Gupta V. et al. Manometric tests of anorectal function in 90 healthy children: a clinical study from Kuwait. J. Pediatr. Surg. 2009; 44 (9): 1786–90.Gruppo Lombardo per lo Studio della Motilita Intestinale. Anorectal manometry with water-perfused catheter in healthy adults with no functional bowel disorders. Colorectal. Dis. 2010; 12 (3): 220–5.Gruppo Lombardo per lo Studio della Motilita Intestinale. Anorectal manometry with water-perfused catheter in healthy adults with no functional bowel disorders. Colorectal. Dis. 2010; 12 (3): 220–5.Stephens F.D. Imperforate rectum. A new surgical technique. Med. J. Australia. 1953; 1: 202.Stephens F.D. Imperforate rectum. A new surgical technique. Med. J. Australia. 1953; 1: 202.Ruttenstock E.M., Zani A., Huber-Zeyringer A., Hцllwarth M.E. Preand postoperative rectal manometric assessment of patients with anorectal malformations: should we preserve the fistula? Dis. Colon. Rectum. 2013; 56 (4): 499–504.Ruttenstock E.M., Zani A., Huber-Zeyringer A., Hцllwarth M.E. Preand postoperative rectal manometric assessment of patients with anorectal malformations: should we preserve the fistula? Dis. Colon. Rectum. 2013; 56 (4): 499–504.Palit S., Lunniss P.J., Scott S.M. The physiologe of human defecation. Dig. Dis. Sci. 2012; 57 (6): 1445–64.Palit S., Lunniss P.J., Scott S.M. The physiologe of human defecation. Dig. Dis. Sci. 2012; 57 (6): 1445–64.Cheeney G., Nguyen M., Valestin J., Rao S.S. Topographic and manometric characterization of the recto-anal inhibitory reflex. Neurogastroenterol. Motil. 2012; 24 (3): e147–54.Cheeney G., Nguyen M., Valestin J., Rao S.S. Topographic and manometric characterization of the recto-anal inhibitory reflex. Neurogastroenterol. Motil. 2012; 24 (3): e147–54.Baek H.N., Hwang Y.H., Jung Y.H. Clinical significance of perineal descent in pelvic outlet obstruction diagnosed by using defecography. J. Korean Soc. Coloproctol. 2010; 26 (6): 395–401.Baek H.N., Hwang Y.H., Jung Y.H. Clinical significance of perineal descent in pelvic outlet obstruction diagnosed by using defecography. J. Korean Soc. Coloproctol. 2010; 26 (6): 395–401.Zhang S.C., Wang W.L., Bai Y.Z. et al. Determination of total and segmental colonic transit time in constipated children. Zhonghua Er Ke Za Zhi. 2003; 41(3): 176–9.Zhang S.C., Wang W.L., Bai Y.Z. et al. Determination of total and segmental colonic transit time in constipated children. Zhonghua Er Ke Za Zhi. 2003; 41(3): 176–9.Campbell A.M., Murphy J., Charlesworth P.B. et al. Dynamic MRI (dMRI) as a guide to therapy in children and adolescents with persistent full thickness rectal prolapse: a single centre review. J. Pediatr. Surg. 2013; 48 (3): 607–13.Campbell A.M., Murphy J., Charlesworth P.B. et al. Dynamic MRI (dMRI) as a guide to therapy in children and adolescents with persistent full thickness rectal prolapse: a single centre review. J. Pediatr. Surg. 2013; 48 (3): 607–13.

The authors declare that there are no conflicts of interest present.