The accuracy of clinical examination in the diagnosis of rectal intussusception.

PURPOSE: This study was designed to compare routine clinical examination and defecography in the diagnosis of rectal intussusception in constipated patients and study relationships between rectal intussusception and symptoms.

METHODS

A total of 127 consecutive patients with functional constipation were examined in the left-lateral position with rectal palpation and rectoscopy according to a protocol. An overall clinical judgment was made if the patient had intussusception, unclear finding, or no intussusception. Defecography was performed without knowledge of the results of the clinical evaluation. Symptom duration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup.

RESULTS

A diagnosis by digital examination ( P = 0.002) and by rectoscopy ( P = 0.002) as well as the overall judgment ( P = 0.0002) was clearly related to a longer intussusception as measured by defecography. Five of six intra-anal intussusceptions were correctly assessed by clinical examination, whereas the correlation to defecography was poor in the group with short intussusceptions. Neither clinical nor defecographic diagnosis of rectal intussusception were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures ( P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01).

CONCLUSIONS

There is no clear relationship between rectal intussusception and constipation. However, intussusception is related to sphincter function and may be of clinical relevance. A normal clinical examination will exclude most long intussusceptions, whereas a positive finding needs further evaluation with defecography.