대한대장항문학회

Purpose : To assess the role of anorectal physiologic study for the diagnosis of chronic<br>idiopathic constipation. Methods : A retrospective study of 81 constipated patients (23 male,<br>58 female) of mean age 48 16.6 (16∼83) years who had no abnormalities in colonoscopy,<br>barium enema, and rectal exam was done. 81 patients underwent defecography and<br>cine-defecography, of which 66 patients underwent anal manometry, 52 patients underwent<br>colonic transit time study (CTT), and 27 patients underwent anal plug electromyography<br>(EMG). Results : Nonrelaxing puborectalis syndrome (NRPR), rectocele, rectal<br>intussusception, anal dyschezia, and sigmoidocele were observed in 27 (33.3%), 26 (32.1%), 14<br>(17.3%), 3 (3.7%), and 2 (2.5%) of the patients, respectively. Normal cinedefecography finding<br>was observed in 21 (25.9%) patients. More than one abnormal finding was found in 11<br>(13.6%) patients. Abnormal findings included colonic inertia in 6 (11.5%) patients and pelvic<br>outlet obstruction in 2 (3.8%) patients. Normal colon transit time was observed in 44 (84.6%)<br>patients. Anal hypertonia was observed in 23 (34.8%) patients by anal monometry, of which<br>3 patients were diagnosed with anal dyschezia in cinedefecography. 13 (48.1%) patients were<br>diagnosed with NRPR in anal plug EMG. The correlation rate between<br>cinedefecography/EMG, defecography/CTT, and CTT/EMG were 81.5%, 61.5%, and 51.9%<br>respectively in the diagnosis of NRPR. Sensitivities of the three tests were 72.7% for<br>cinedefecography, 66.7% for EMG, and 7.7% for CTT in diagnosing NRPR (p＜0.05). Positive<br>predictive values of the three tests were 80% for anal plug EMG, 72.7% for cinedefecography,<br>and 50% for CTT in the diagnosis of NRPR. Conclusions : Defecography and EMG were<br>complements each of the other in diagnosis of pelvic outlet obstruction especially NRPR, but<br>CTT has no role.<br>