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Background <p>Patients with intermediate and high-type anorectal malformations (ARMs) demonstrate moderate to severe fibrosis in the distal rectal wall, which may underlie postoperative defecation dysfunction. This study aims to systematically evaluate and quantitatively analyze collagen deposition patterns in the distal rectal wall, providing new insights into the mechanism of defecation disorders following anorectal reconstruction.</p> Methods <p>We conducted an integrated analysis of 30 intermediate/high-type ARMs patients utilizing histochemical staining, immunohistochemistry, and Western blot to quantitatively evaluate spatial extracellular matrix (ECM) composition and fibrotic architecture in the distal rectal wall.</p> Results <p>Microscopic examination revealed densely packed collagen fibers within the submucosal layer and prominent perineural collagen deposition surrounding the myenteric plexus in distal segments. Quantitative analysis demonstrated significantly greater perineural connective tissue thickness in distal versus proximal intestinal wall (<i>P</i> &lt; 0.001). Both type I (<i>P</i> &lt; 0.001) and type III (<i>P</i> = 0.039) collagen expression were significantly elevated in distal segments, with a notably increased type I/III collagen ratio (<i>P</i> = 0.014).</p> Conclusion <p>The distal rectal wall in intermediate and high-type ARMs patients exhibits abnormal ECM deposition characterized by significantly increased type I and III collagen, with predominant type I collagen elevation. These findings suggest a mature, stiffened fibrotic phenotype with impaired tissue compliance and structural irreversibility. The distinctive collagen deposition profile identified in this study may be critically associated with the pathogenesis of postoperative defecation dysfunction in ARM patients.</p>

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Analysis of terminal rectal fibrosis and expression of type I and type III collagen proteins in patients with mid-high anorectal malformations

  • 期刊论文

  • 发表日期：

    2026年4月21日

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  • Siqi Li,
  • Meng Wang,
  • Huan Li,
  • Wei Chen,
  • Yidi Chi,
  • Long Li

摘要

Background

Patients with intermediate and high-type anorectal malformations (ARMs) demonstrate moderate to severe fibrosis in the distal rectal wall, which may underlie postoperative defecation dysfunction. This study aims to systematically evaluate and quantitatively analyze collagen deposition patterns in the distal rectal wall, providing new insights into the mechanism of defecation disorders following anorectal reconstruction.

Methods

We conducted an integrated analysis of 30 intermediate/high-type ARMs patients utilizing histochemical staining, immunohistochemistry, and Western blot to quantitatively evaluate spatial extracellular matrix (ECM) composition and fibrotic architecture in the distal rectal wall.

Results

Microscopic examination revealed densely packed collagen fibers within the submucosal layer and prominent perineural collagen deposition surrounding the myenteric plexus in distal segments. Quantitative analysis demonstrated significantly greater perineural connective tissue thickness in distal versus proximal intestinal wall (P < 0.001). Both type I (P < 0.001) and type III (P = 0.039) collagen expression were significantly elevated in distal segments, with a notably increased type I/III collagen ratio (P = 0.014).

Conclusion

The distal rectal wall in intermediate and high-type ARMs patients exhibits abnormal ECM deposition characterized by significantly increased type I and III collagen, with predominant type I collagen elevation. These findings suggest a mature, stiffened fibrotic phenotype with impaired tissue compliance and structural irreversibility. The distinctive collagen deposition profile identified in this study may be critically associated with the pathogenesis of postoperative defecation dysfunction in ARM patients.