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The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

Purpose

The sigmoidorectal junction (SRJ) has been defined as an anatomical sphincter with particular physiological behavior that regulates sigmoid and rectum evacuation. Its function in clinical conditions, such as diverticular disease has been advocated. The aim of our study is to identify the SRJ and to compare the morphometric and dynamic features of the SRJ between patients with diverticular disease and healthy subjects using MR-defecography.

Methods

Sixteen individuals, eight with uncomplicated diverticular disease and eight healthy subjects, were studied using MR-defecography to identify the SRJ and to compare the morphometric and dynamic features observed.

Results

In each subject studied, MR-defecography was able to identify the SRJ. This resulted in the identification of a discrete anatomical entity with a mean length of 31.23 mm, located in front of the first sacral vertebra (S1) and at a mean distance of 15.55 cm from the anal verge, with a mean wall thickness of 4.45 mm, significantly different from the sigmoid and rectal parietal thickness. The SRJ wall was significantly thicker in patients with diverticular disease than the controls (P = 0.005), showing a unique shape and behavior in dynamic sequences.

Conclusion

Our findings support the hypothesis that SRJ plays a critical role in patients with symptomatic diverticular disease; further investigation may clarify whether specific SRJ analysis, such as MR-defecography, would predict inflammatory complications of this diffuse and heterogenic disease.

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Acknowledgments

We acknowledge Drs. Nathasha Marasco and Hugh Holt (London, UK) for their assistance in manuscript preparation and proof reading.

Conflict of interest

Authors declare that there have no conflicts of interest in this manuscript.

Ethical standard statement

The authors ensure that any experimental investigation reported in the manuscript was performed with informed consent and following all the guidelines for experimental investigation with human subjects required by the institutions with which all the authors are affiliated and in according with the current law of the country in which the research was performed.

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Authors and Affiliations

  1. DEAII, Emergency Department, Umberto I Policlinico di Roma, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy

    Francesco Romagnoli, Maria Chiara Colaiacomo, Ritanna De Milito, Claudio Modini, Gianfranco Gualdi & Marco Catani

  2. Imaging Department Unit, Umberto I Policlinico di Roma, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy

    Maria Chiara Colaiacomo & Gianfranco Gualdi

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  1. Francesco Romagnoli
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  2. Maria Chiara Colaiacomo
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  3. Ritanna De Milito
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  4. Claudio Modini
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  5. Gianfranco Gualdi
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  6. Marco Catani
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Correspondence to Francesco Romagnoli.

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Romagnoli, F., Colaiacomo, M.C., De Milito, R. et al. The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography. Surg Radiol Anat 36, 85–90 (2014). https://doi.org/10.1007/s00276-013-1133-1

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  • DOI: https://doi.org/10.1007/s00276-013-1133-1

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