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Vectormanometry for differential diagnosis of fecal incontinence
J C Braun1, K H Treutner, B Dreuw
1Department of Surgery, Medical Faculty, Rhenish-Westphalian Technical University, Aachen, Germany.
Purpose:
This study was designed to investigate the reliability of three-dimensional vectormanometry for differential diagnosis of fecal incontinence.
Methods:
Eight-channel, continuous pull-out perfusion manometry was performed on 23 female patients with traumatic (n = 11) or idiopathic (n = 12) incontinence, respectively.
Results:
At rest, the minimum sector pressure of patients with traumatic incontinence (32 +/- 14 mmHg) was significantly lower than it was in the controls (76 +/- 16 mmHg) and in those with idiopathic incontinence (64 +/- 28 mmHg) (P < 0.001). At maximum squeezing, the minimum sector pressure was 57 +/- 22 mmHg in patients with traumatic incontinence and 79 +/- 33 mmHg in those with idiopathic incontinence, both being significantly lower than in the control group with 152 +/- 27 mmHg (P < 0.001). The asymmetry index of the patients with a sphincter defect was significantly higher, both at rest (23 +/- 13 percent) and squeeze (26 +/- 12 percent), in comparison with the control group (7 +/- 2 percent at rest and 6.2 +/- 1.6 percent at squeeze) and the patients with idiopathic incontinence (10 +/- 5 percent at rest and 8.4 +/- 4 percent at squeeze).
Conclusion:
Three-dimensional vectormanometry identifies localized pressure deficits in the anal canal, thereby differentiating between sectorial and global sphincter insufficiency.