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PubMed1988

Solitary rectal ulcer syndrome: findings at barium enema study and defecography.

Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis.

Adult↗

PubMed1990

Radiation dose in defecography.

The effective dose equivalent, as an expression of total patient risk for exposure to limited areas of the body, and gonadal doses associated with hereditary effects were estimated in 67 consecutive subjects (43 women and 24 men) who underwent defecography. With use of measured entrance exposure values and data from Monte Carlo simulations, the mean effective dose equivalent was estimated at 4.9 mSv +/- 1.6 (490 mrem +/- 160) for women and 0.6 mSv +/- 0.2 (60 mrem +/- 20) for men. The ovarian dose was 15 mSv +/- 5 (1.5 rem +/- 0.5). The testes are not within the primary beam and therefore are exposed to scattered radiation only, hence the low received dose of 0.14 mSv or less (14 mrem or less). These data indicate that defecography is among the radiologic procedures associated with a considerable, but not extreme, radiation dose.

Adult↗

PubMed1993

Functional disorders of the anus and rectum: findings on defecography.

In the past decade, interest in the anorectal region and the mechanism of continence and defecation has been increasing. Subsequently, techniques to visualize the anorectum have been introduced; evacuation proctography and defecography have been used to describe the dynamic radiologic evaluation of this area. Also, developments in anorectal manometry, electromyography, and transrectal sonography have renewed interest in defecography, particularly in categorizing the functional disorders including rectocele, intussusception and prolapse, enterocele, descending perineum syndrome, dyskinetic puborectalis muscle, solitary rectal ulcer syndrome, and incontinence.

Anal Canal↗

PubMed1992

[Defecography and manometry in the postoperative follow-up of patients treated with colo-anal anastomosis by the Parks technique for neoplasm stenosis of the rectum].

The Authors report 15 cases of patients with adenocarcinoma of the rectum who were treated using Park's resection. Morphofunctional parameters are evaluated 3 months after surgery using defecography and manometry before the closure of the neostoma and the reactivation of the ano-rectal canal. Opaque defecography enables the morphology and dimensions of the anal canal to be examined together with modifications to the area between the rectum and the anal canal, and the impression of the pubo-rectal sling. In conclusion these data confirm the importance of surgery, whereas the correlation between defecographic and manometric results allows the functional recovery "ad integrum" of the area to be checked.

Adenocarcinoma↗

PubMed1992

[Radiation exposure during defecography].

The introduction of a new radiological method requires the assessment of the advantage-risk ratio. On measuring the radiation doses during defecography, skin entrance and gonadal exposure values were found to be lower than during well-known and well-established examinations of the small pelvis, such as colon enema and CT of the lower abdomen. Defecography, as a radiological tool for diagnosing the anorectal function is, therefore, also suitable for young persons.

Defecation↗

PubMed1991

[Constipation and incontinence: significance of colonic transit time, anorectal manometry and defecography].

Constipation and fecal incontinence are frequent motives of gastroenterological consultation. An etiological diagnosis can often be suspected from the history and can be confirmed by functional testing. We here report our experience with the measurement of colonic transit time (TTC), anorectal manometry (MAR) and defecography (D). Whilst TTC was unhelpful, MAR revealed abdomino-pelvic asynchrony (anismus) in 60 constipated patients and 7 (47%) of 15 incontinent patients. Perineal descent was suspected in 25 constipated patients and confirmed by defecography, which also revealed associated static pelvic disorders. Our experience confirms the role of functional exploration in the investigation of constipation and fecal incontinence and permits a more precise therapeutic approach.

Adult↗

PubMedDate not supplied

[Digital videoradiography applied to the study of the recto-anal region during defecography].

The authors have employed a real-time fluoroscopic computerized equipment during defecography. Digitalized images were acquired at a rate of three frames/s and then processed and became immediately available. Digital defecography was employed in 67 patients with various anorectal diseases--i.e., rectocele, descending perineum, rectal prolapse, non-relaxing puborectalis syndrome and fecal incontinence. We found time-interval difference (TID) technique especially useful for it allowed different functional phases of defecation to be depicted on a single subtracted image and an evaluation of the movements of anorectal region. The high contrast resolution of the computerized equipment demonstrated even minimal contrast medium leaks in fecal incontinence. The examination is easy and rapid to perform with a low radiation dose to the patients.

Defecation↗

PubMed1995

Defecography.

Defecography, a dynamic imaging modality, plays an important role in the diagnosis of functional and morphologic abnormalities of the anorectal region. We have here summarized the principle and techniques as well as observations of defecography, with special emphasis on morphologic measurements, clinical relevance, and limitations. The application of MR imaging in examination of anorectal function has also been addressed.

Barium Sulfate↗

PubMed1995

Perineal descent at defecography in women with straining at stool: a lack of specificity or predictive value for future anal incontinence?

OBJECTIVE: To determine (1) whether patients complaining of straining at stool have pelvic floor descent and anal abnormalities similar to those of patients with anal incontinence and (2) whether these patients are prone to develop anal incontinence. METHODS: To answer the first question we used defecography to study perineal floor position at rest, during maximal contraction of the anal sphincter and during straining, and we performed anorectal manometry in 46 women with straining at stool but without anal incontinence at the beginning of the study, and in 46 women with idiopathic anal incontinence, matched for age. To answer the second question, we performed a 5-year follow-up study to determine whether anal incontinence had developed in those women with straining at stool. RESULTS: Perineal floor position at rest, during maximal contraction of the sphincter and during straining, resting pressure in the upper part of the anal canal, maximal amplitude and duration of the voluntary contraction were similar in the 46 women with straining at stool and the 46 women with idiopathic anal incontinence. In the follow-up study, 24 of the 46 women with straining at stool were contacted. The incidence of anal incontinence after 5 years was higher among these 24 women than in a control group of 20 women (13 out of 24 versus three out of 20, for women with straining at stool versus controls respectively; P < 0.01). The 13 patients with straining at stool who became incontinent had, at the initial investigation, a lower maximal amplitude of voluntary contraction, greater perineal descent at rest and less elevation of the pelvic floor during maximal contraction of the anal sphincter than the other women (P < 0.05). CONCLUSION: Women with chronic straining at stool have perineal descent at rest and during straining similar to that of incontinent women. Women with chronic straining are also prone to develop anal incontinence, suggesting that perineal descent at defecography in women with straining at stool may predict future anal incontinence.

Aged↗

PubMedDate not supplied

[Defecography in internal invagination of the rectum].

Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). In the present study defecographies performed on 15 patients, with previous diagnosis of rectal invagination have been reviewed. Six patients had an intra-rectal (IR) invagination, three had an intra-anal (IA) invagination, while two patients did not show a typical rectal invagination. In the present series there is a suspected radiologic recurrence of the invagination. Three patients show a tendency to rectal stenosis. Anorectal angles at rest and under straining appears higher than the ones in normal subjects, after rectopexy, anorectal angles do not appear to be significantly changed and the pelvic floor is not significantly raising post-operatively. 7 out of 10 women had a rectocele preoperatively and 4 out 9 postoperatively. In 8 patients it was possible to compare a pre to a post-operative defecography. All patients but one displayed a reduction in the ability in emptying the rectum. The fact that rectal emptying is impaired may suggest that some autonomic denervation might occur following rectal mobilization.

Adult↗

PubMed1994

[The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)].

The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

[Defecography in the diagnosis of fecal incontinence: an analysis of the receiver operating characteristic (ROC)].

Two groups of patients with altered bowel habit and pelvic floor dysfunction, but comparable epidemiologic characteristics (i.e. n = 105 each; mean age and SD 47.3 +/- 15.8 yrs vs. 54.9 +/- 16.7 yrs; range 15-80 yrs vs. 9-88 yrs; F/M ratio 28:1 vs. 2.6:1) with the exception of the absence (or presence) of fecal incontinence, were examined with defecography, taking into account criteria other than anorectal angle values and anorectal junction mobility. At the Receiver Operating Characteristic (ROC) analysis a "barium leak sign", occurring either at rest or on straining was found to be a highly reliable index of fecal incontinence (specificity: 100% and 92-93%, respectively, intraobserver agreement K value = 0.82, Z = 21.58, p < 0.001). A false negative rate of 14.2% was limited to "minor" incontinence only, i.e., incontinence to gas and/or occasional staining episodes. In the search for an etiologic diagnosis, useful adjunctive criteria included (a) anal diameter > 10 mm at rest; (b) poor stop test (inability to interrupt the barium stream); (c) rectal diameter > 6.5 cm and < 4 cm (abnormally increased and reduced compliance, respectively). Defecography is a useful diagnostic tool in fecal incontinence and should precede anal endosonography, manometry and electromyography for proper therapeutic decision-making and in risk conditions, e.g., in the patients about to undergo elective pelvic surgery.

Adolescent↗

PubMed1998

[Evacuation defecography and defecoflometry in diagnosis of chronic constipation. A prospective comparative study of 49 patients].

Chronic constipation can be divided in two large groups: slow-transit constipation, caused by pathological intestinal transit, and obstructive defecation disorder, caused by pelvic and rectal wall abnormalities. Videodefecography and defecoflowmetry are methods used to study dynamic evacuation of the rectum. Videodefecography also enables visual estimation of rectal evacuation. Defecoflowmetry allows analysis of anal and rectal pressures. Within this prospective study we utilized and compared these methods in 19 patients with slow transit and 30 patients with obstructive disease. In patients with slow transit, both investigations demonstrated a significantly higher defecation rate than in obstructive defecation disorder (slow transit: defecoflowmetry 65%, videodefecography 80%; obstructive defecation disorder: 50% and 58%). The evacuation time was pathologically prolonged in both types of constipation, with a range of 43-55 s. Rectoceles are demonstrated in 94% of cases with slow transit and in 72% with obstructive defecation disorder. Also, we often found obstructive components in slow-transit constipation patients. Normal defecography or defecoflowmetry can rule out obstructive defecation disorder. We conclude that videodefecography and defecoflowmetry are important items in the complex diagnostic regimen needed in evaluation of chronic constipation.

Adult↗

PubMedDate not supplied

Vaginal opacification during defecography: utility of placing a folded gauze square at the introitus.

We evaluated the value of placement of a folded gauze square into the urogenital introitus to improve vaginal opacification in 90 patients who underwent defecography. Of the 50 patients who retained the gauze in the introitus, 96% demonstrated excellent or good vaginal opacification. By contrast, only 75% of the 40 patients who lost the gauze during the study were able to achieve the same level of opacification. This difference was shown to be statistically significant (p < 0.002), suggesting that placement of a folded gauze square in the introitus limits loss of contrast from the vagina, which improves vaginal opacification.

Adult↗

PubMed1999

Defecography: does parity play a role in the development of rectal prolapse?

Few studies related to parity address the changes in anorectal function in women. Since the majority of patients with rectal prolapse are women, we undertook this study to assess the role of parity in the development of rectal prolapse. We retrospectively reviewed defecography studies performed on 354 female patients over a 10-year period. Studies noting the presence of intra-anal and external rectal prolapse (full thickness protrusion of the rectum into and through the anal sphincter) were reviewed. Cases with intrarectal or hidden rectal prolapse, a condition of lesser clinical importance, were excluded. The obstetric histories of the patients with rectal prolapse (n = 27) were compared to those of patients without rectal prolapse (n = 88). There was a larger proportion of nulliparous women in the rectal prolapse group than in the group without rectal prolapse, suggesting that factors in addition to parity play a role in the development of rectal prolapse. However, parous women with rectal prolapse had delivered significantly more children (3.3) than parous women without prolapse (2.5) (P = 0.03). The exact cause of rectal prolapse remains unclear. Childbearing appears to play a limited role in its pathogenesis since nulliparous women are also at risk of developing rectal prolapse.

Defecography↗

PubMedDate not supplied

[Enterocele: clinical risk factors and association with others pelvic floor disorders (about 544 defecographies)].

OBJECTIVE: To study, by means of defecography, clinical risk factors of enterocele and association with others pelvic floor disorders. PATIENTS AND METHODS: Five hundred and forty-four consecutive female patients were investigated by colpocystodefecography with contrast medium in the small bowel. One hundred and thirty-six women with enterocele were compared to 408 women without enterocele. RESULTS: There were no significant differences in age, obstetrical history (parity, foetal macrosomia, instrumental extractions or perineal tear to delivery) between the two groups. More women with enteroceles had histories of hysterectomies (60% versus 24%) or cystopexies (29% versus 13%). Others pelvic floor disorders were associated in 91% of enterocele: rectocele (25%), cystocele (42%), uterine prolapse (28%), rectal intussusception (52%), rectal prolapse (4%) and abnormal perineal descent (30%). Stress urinary incontinence was significantly more frequent in women without enterocele. DISCUSSION AND CONCLUSIONS: The study has demonstrated that previous hysterectomy and cystopexy increased the risk of enterocele formation and that enterocele and others pelvic floor disorders are often concomitant. Enterocele may have a pessary effect on urinary disorders. Results of colpocystodefecography reinforce the notion of pelvic floor local disease.

Adult↗

PubMed1994

Reproducibility of five anorectal morphologic measurements in defecography.

RATIONALE AND OBJECTIVES: We evaluated the inter- and intraobserver reproducibility of measuring five morphologic parameters of the anorectum in defecography (evacuation proctography). METHODS: Measurements from 42 defecographic studies were statistically analyzed. The parameters measured during resting, squeezing, and straining included two anorectal angles (posterior and axis), maximal width of the anal canal, maximal width of the rectal lumen, and size of the rectocele. RESULTS: The results demonstrated only fair interobserver agreement (kappa = 0.22-0.38) for almost all measurements of the five morphologic parameters. There were high correlations (kappa = 0.62-1.00) among most intraobserver measurements. CONCLUSION: For defecographic measurement, the five parameters we studied have relatively poor clinical value because of high inter- and intraobserver inconsistency.

Adult↗

PubMed2001

[Dynamic MR defecography for diagnosis of combined functional disorders of the pelvic floor in proctology].

PURPOSE: Evaluation of magnetic resonance defecography in the diagnosis of pelvic floor disorders were examined prospectively. MRI was performed on a 1.5 T scanner. The rectum was opacified with 200 ml of ultrasound transmission gel. A sagittal single section T2-weighted gradient echo sequence with a temporal resolution of 1.1 second was performed. Changes of the anorectal angle and the position of the pelvic organs in relation to the pubococcygeal line were registered at rest, during straining, and during evacuation of the rectum. RESULTS: Patients with obstructed defecation (n = 15) showed prolapse of the rectal mucosa (n = 5), anterior rectocele (n = 8), pelvic floor descent (n = 5), enterocele (n = 2), and anorectal dyscoordination (n = 3). Individuals with stool incontinence (n = 15) had an anterior rectocele (n = 10), pelvic floor descent (n = 11), enterocele (n = 2), prolapse of rectal mucosa (n = 1), and a puborectal insufficiency (n = 1). Urine incontinence was associated with cystocele (n = 10) or normal findings (n = 4). In patients with unspecific symptoms (n = 6), anorectal dyscoordination (n = 4) and prolapse of the rectal mucosa (n = 2) were found. MRI was superior for the detection of enteroceles, cystoceles and pelvic floor descent compared with clinical investigation. CONCLUSION: Dynamic MR imaging supplies complex information in anorectal disease and thus improves proctoscopy.

Adolescent↗