A defecografia na constipação intestinal associada a hipercontratilidade do diafragma pelvico diagnosticado pela manometria anorretal
Irene Harumi Kamata Barcelos
TESE
Português
(Broch.)
T/UNICAMP B235d
Campinas, SP : [s.n.], 2000.
97p. : il.
Orientadores: Juvenal Ricardo Navarro Goes, Livio Nanni
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Resumo: Durante a defecação, a musculatura do diafragma pélvico e os esfincteres anais, que mantêm o tônus de repouso, necessitam de relaxamento para permitir a descida do períneo e abertura do canal anal. Alguns pacientes, com sintoma de constipação intestinal, podem ter este mecanismo de inibição...
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Resumo: Durante a defecação, a musculatura do diafragma pélvico e os esfincteres anais, que mantêm o tônus de repouso, necessitam de relaxamento para permitir a descida do períneo e abertura do canal anal. Alguns pacientes, com sintoma de constipação intestinal, podem ter este mecanismo de inibição da atividade muscular alterado, com conseqüente obstrução funcional. No período de janeiro de 1997 a janeiro de 1999 foram avaliados vinte e dois pacientes com constipação intestinal crônica idiopática que apresentaram na manometria anorretal pressão anal de repouso elevada e diferencial de pressão entre a pressão máxima de contração voluntária e a. pressão média de repouso em níveis expressos pela equação: Diferencial de pressão < 2 PMR + 0,2 (2 PMR). A este estado foi denominado 'hipercontratilidade da musculatura esfincteriana e do diafragma pélvico'(HEDP). Os pacientes foram submetidos a defecografia para investigar quais as alterações que possivelmente estivessem associadas com este 'status' manométrico. O principal sintoma do distúrbio de defecação foi separado em predomínio da dificuldade de iniciar a evacuação, predomínio da sensação de evacuação incompleta e mista (sem predomínio). A defecografia destes pacientes foram comparadas a defecografia de indivíduos assintomáticos, e posteriormente foram comparadas com o sintoma predominante da dificuldade de evacuação, com a retenção de níarcadores intestinais radiopacos do trâpsito cólico na região retossigmóide, com a pressão média de repouso, pressão máxima de contração voluntária e com o diferencial de pressão. Não houve um padrão definido nas alterações encontradas nos exames defecográficos dos pacientes que possuem o diagnóstico mano métrico de HEDP. O ângulo anorretal medido nas diversàs fases do exame, e o percentual de variação do ângulo anorretal na contração em relação ao repouso e na evacuação em relação ao repouso, e o nível de descida do períneo durante a evacuação não foram discriminatórios. O percentual de resíduo pós-evacuação, o tempo de esvaziamento e o diâmetro do canal anal foram significativos com a condição mano métrica, porém apresentaram perfil semelhante aos pacientes constipados de maneira genérica. A retenção dos marcadores na região retossigmoideana no trânsito cólico não foi concordante com o esvaziamento retal na defecografi~ exceto nos casos isolados de diagnóstico defecográfico de evacuação obstruída por diafragma pélvico espástico (DiPE). A manifestação clínica de dificuldade de iniciar a evacuação foi preponderante sobre a sensação de evacuação incompleta. Os pacientes com dificuldade de iniciar a evacuação tiveram maior percentual de resíduo pós-evacuação do que os pacientes com sensação de evacuação incompleta. As variáveis da defecografia são independentes da manometria anorretal, e possivelmente as anormalidades da defecografia são conseqüência do esforço prolongado causado provavelmente pelos níveis de pressão do canal anal
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Abstract: During defecation, pelvic floor muscles and anal sphincters, which are responsible for the resting pressure, need to relax in order to allow a descent of the perineum and open the proximal portion of the anal canaL Some constipated patients may have this inhibitory mechanism altered and,...
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Abstract: During defecation, pelvic floor muscles and anal sphincters, which are responsible for the resting pressure, need to relax in order to allow a descent of the perineum and open the proximal portion of the anal canaL Some constipated patients may have this inhibitory mechanism altered and, consequent1y, an obstructed defecation. During the period of January 1997 to January 1999, twenty-two patients with chronic idiopathic intestinal constipation and elevated anal median resting pressure (PMR) associated with a decreased differential of pressure between maximal squeeze and resting pressure were evaluated.
Maximal squeeze pressure was determined by the equation: 2.PMR + 0,2 (2PMR). This functional state was named "Pelvic floor and sphincters musculature hipercontraction" (HEDP). Patients underwen~ defecography examination in order to identify possible alterations associated with this functional manometric status (HEDP). The main symptom of altered defecation was divided in three categories: predominance of difficulty to initiate defecation, predominance of sensation of incomplete evacuation, and mixed condition. The exams were compared with control asymptomatic subjects and thereafter compared with the main symptom of difficult evacuation, intestinal markers retentiQn in recto-sigmoid region, median resting pressure, maximal squeeze pressure and pressoric differential lt was observed that there was not a defined standard of defecography fmdings in these patients having HEDP status. The anorectal angle obtained in the different phases of the examination, the percentage of variation of the anorectal angle during contraction and resting time, during evacuation and resting time, and the leveI of perineum descent, did not show any particular characteristic. The percentage of post-evacuation residue, time of rectal emptying and diameter of the anal canal were significant1y associated with manometric fmdings, however they were a common finding for patients having constipation in general.
Retention of colonic markers in the recto-sigmoid region was not in accordance with rectal emptying studied in defecography, with the exception of some cases having the defecographic diagnosis of obstructed evacuation due to spastic pelvic floor (DiPE).
Clinical manifestation of difficulty to initiate the evacuation was predominant over the sensation of incomplete evacuation. Patients with the difficulty to initiate evacuation had a larger percentage of residue afier evacuation when compared with patients having the sensation of incomplete evacuation. The defecography variables are independent of manometric variables, and possibly the abnormalities observed in the defecography are consequence of prolonged effort due to the elevated levels of anal resting pressure Ver menos
Maximal squeeze pressure was determined by the equation: 2.PMR + 0,2 (2PMR). This functional state was named "Pelvic floor and sphincters musculature hipercontraction" (HEDP). Patients underwen~ defecography examination in order to identify possible alterations associated with this functional manometric status (HEDP). The main symptom of altered defecation was divided in three categories: predominance of difficulty to initiate defecation, predominance of sensation of incomplete evacuation, and mixed condition. The exams were compared with control asymptomatic subjects and thereafter compared with the main symptom of difficult evacuation, intestinal markers retentiQn in recto-sigmoid region, median resting pressure, maximal squeeze pressure and pressoric differential lt was observed that there was not a defined standard of defecography fmdings in these patients having HEDP status. The anorectal angle obtained in the different phases of the examination, the percentage of variation of the anorectal angle during contraction and resting time, during evacuation and resting time, and the leveI of perineum descent, did not show any particular characteristic. The percentage of post-evacuation residue, time of rectal emptying and diameter of the anal canal were significant1y associated with manometric fmdings, however they were a common finding for patients having constipation in general.
Retention of colonic markers in the recto-sigmoid region was not in accordance with rectal emptying studied in defecography, with the exception of some cases having the defecographic diagnosis of obstructed evacuation due to spastic pelvic floor (DiPE).
Clinical manifestation of difficulty to initiate the evacuation was predominant over the sensation of incomplete evacuation. Patients with the difficulty to initiate evacuation had a larger percentage of residue afier evacuation when compared with patients having the sensation of incomplete evacuation. The defecography variables are independent of manometric variables, and possibly the abnormalities observed in the defecography are consequence of prolonged effort due to the elevated levels of anal resting pressure Ver menos
A defecografia na constipação intestinal associada a hipercontratilidade do diafragma pelvico diagnosticado pela manometria anorretal
Irene Harumi Kamata Barcelos
A defecografia na constipação intestinal associada a hipercontratilidade do diafragma pelvico diagnosticado pela manometria anorretal
Irene Harumi Kamata Barcelos
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