Iatrogenic rectal diverticulum in patients treated with transanal stapled techniques

• Published in: Radiologia medica 2008-09, Vol.113 (6), p.887-894
• Main Authors: Alabiso, M. E., Grassi, R., Fioroni, C., Marano, I.
• Format: Article
• Language: English
• Subjects: Constipation - surgery; Defecography; Diagnostic Radiology; Diverticulum - diagnostic imaging; Diverticulum - etiology; Fecal Impaction - surgery; Female; Gastrointestinal radiology/Radiologia gastrointestinale; Hemorrhoids - surgery; Humans; Iatrogenic Disease; Imaging; Interventional Radiology; Male; Medicine; Medicine & Public Health; Neuroradiology; Postoperative Complications; Radiology; Rectal Diseases - diagnostic imaging; Rectal Diseases - etiology; Surgical Staplers - adverse effects; Surgical Stapling - adverse effects; Syndrome; Ultrasound
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-008-300-7

Purpose The aim of this study was to demonstrate the possibility of rectal diverticula developing in patients treated with endoanal circular staplers for haemorrhoids (Longo’s stapled haemorrhoidectomy) or obstructed defaecation syndrome [stapled transanal rectal resection (STARR)]. Materials and methods Between January 2005 and December 2006, we carried out 634 defaecographic examinations. Of these, 45 were postoperative follow-up studies of patients who had been treated with the Longo technique (n=13) or STARR technique (n=32). Results Seven out of 45 patients, five of whom were women treated with the Longo technique and two men with the STARR technique, developed rectal diverticula. One diverticulum was located on the left lateral rectal wall, four on the posterior wall and two on the anterior wall. All diverticula had arisen from the surgical suture point. In one case, the diverticulum was discovered incidentally during a double-contrast barium enema. One of the male patients, who had been treated with the Longo procedure 5 years earlier, developed acute pain due to faecal stasis in a widenecked diverticulum abutting the posterior rectal wall. Conclusions The use of endorectal stapling devices can lead to focal weakness at the point of surgical suture on the rectal wall and predispose to the development of rectal diverticula.