Pathogenesis and Treatment of Anal Outlet Obstruction: A clinical analysis of

Kim, Jin Cheon; Lee, Han Il; Park, Sang Kwu; Yu, Chang Sik; Chung, Hee Won

Abstract

Anal outlet obstruction(AOO), which was caused by various anal diseases, presented symptoms like acute or chronic constipation, obstipation, painful defecation and bleeding. We retrospectively reviewed these patients to identify underlying diseases, corresponding surgical treatment and outcome. From July 1989 to December 1995, 132 patients were operated for AOO at Asan Medical Center. Colonic inertia and other pelvic outlet obstructions such as rectocele, rectal intussusception, or Paradoxical puborectalis conraction were excluded from this study by history taking, physical examination, colon transit time study, manometry, and defecography. Male to female ratio was 1 : 1.2 and mean age was 45 and 44, respectively. Among 132 Patients, 57 cases(43%) had sing1e disease and remained 75 cases had combined two or more diseases. Hemorrhoids(90 cases) was the most common associated disease and then were anal stricture(59 cases), chronic anal fissure(29 cases), internal sphincter hypertonia(25 cases) and anal fistula(6 cases) in decreasing order. Either single or combined hemorrhoidectomy was performed in 85 cases, lateral internal sphincterotomy in 65 cases, anoplasty in 35 cases, rubber band ligation in 13 cases, manual anal dilatation in 10 cases. Postoperative complications were 7 cases of wound infection and one case of gas incontinence, that were subsided by conservative management. 119 patients(90%) showed complete improvement and twelve patients were partially improved from AOO. Only one patient did not respond surgical treatment due to anismus. As AOO is a comprehensive disease entity of frequent anal diseases, adequate surgery for respective patients mandatory to relieve discomfort.