Shafik A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Egypt.
Surg Laparosc Endosc. 1997 Apr;7(2):116-20.
A physiological sphincter exists at the rectosigmoid junction; this rectosigmoid sphincter (RSS) relaxes on sigmoid colon contraction and contracts on rectal contraction. Eight cases of RSS hypertonia are presented herein. Six women and two men (mean age, 44.2 +/- 10.3 years) complained of chronic constipation of 9.6 +/- 6.2 years' duration. They had had normal bowel habits before that time. Anorectal physiologic studies were performed. Intestinal transit was delayed by the accumulation of pellets in the sigmoid colon. Defecography and electromyography of the external anal sphincter and levator ani muscle were normal. The resting pressure was normal in the sigmoid colon, rectum, and rectal neck (p > 0.05) but elevated in the RSS (p < 0.01). The sigmoidorectal inhibitory and excitatory reflexes were absent. Biopsies from the sigmoid colon and rectum showed normal histologic findings, but those from the RSS were aganglionic. A diagnosis of RSS "achalasia" was made. Five of the eight patients had improvement as a result of RSS dilatation. The remaining three patients underwent sigmoidomyotomy. The eight patients are now 9 to 38 months without recurrence of constipation. Rectosigmoid junction achalasia constitutes a clinicopathologic entity that should be considered in the etiology of constipation.
直肠乙状结肠交界处存在生理性括约肌；这种直肠乙状结肠括约肌（RSS）在乙状结肠收缩时松弛，在直肠收缩时收缩。本文报告8例RSS张力亢进病例。6名女性和2名男性（平均年龄44.2±10.3岁）主诉慢性便秘，病程9.6±6.2年。在此之前他们的排便习惯正常。进行了肛肠生理学研究。由于乙状结肠内粪便积聚，肠道运输延迟。排粪造影以及肛门外括约肌和肛提肌的肌电图检查均正常。乙状结肠、直肠和直肠颈部的静息压力正常（p>0.05），但RSS处升高（p<0.01）。乙状结肠直肠抑制性和兴奋性反射缺失。乙状结肠和直肠活检组织学检查结果正常，但RSS活检显示无神经节。诊断为RSS“失弛缓症”。8例患者中有5例因RSS扩张而病情改善。其余3例患者接受了乙状结肠肌切开术。这8例患者目前已9至38个月，便秘未复发。直肠乙状结肠交界处失弛缓症构成一种临床病理实体，在便秘病因中应予以考虑。
