Role of dynamic magnetic resonance imaging in management of obstructed defecation case series

Abstract

Aims Surgical treatment of obstructed defecation (OD) carries frequent recurrences. The aim of the study was to evaluate the role dynamic magnetic resonance imaging defecography, and to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients in order to minimize failures. Patients and methods Forty consecutive constipated patients with OD symptoms (31 females) with mean age 48.15 ± 14.29 years. They underwent perineal examination, proctoscopy, anorectal manometry and Dynamic MRI defecography. The different pelvic floor morphology was recorded. The type and outcome of treatment whether conservative or surgical were also recorded. Results The dynamic MRI of the pelvic floor showed 23 patients with descending perineum, 32 rectoceles (28 females), 12 cystoceles (10 females), 6 enteroceles (4 females), 18 intussusceptions (14 females), and 7 dyskinetic puborectalis muscle (3 females). The diagnosis of combined pelvic floor disorders with dynamic MRI defecography was consistent with clinical results in 70% and there were additional diagnostic parameters in 30% of patients. Dynamic MRI findings changed treatment decision in 8 patients 20% with surgical treatment performed in 25 patients (8 stappled trans-anal rectal resection, 11 trans-anal Delorme's, 6 trans-abdominal combined repair), and conservative treatment in 15 patients. Conclusions Dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in OD and interdisciplinary treatment.