Diagnosis Of Rectocele Research Articles

Сравнение методов обычной и магнитно-резонансной дефекографии для диагностики дисфункции тазового дна у пациентов с ожирением

Актуальность. Синдром обструкции принадлежит к дисфункциям тазового дна, которые являются причиной неполной эвакуации кала из прямой кишки. Дефекография — первый шаг для диагностики указанного синдрома. Свободный выбор плоскостей визуализации, разрешение и контраст мягких тканей с лучшей модальностью изображения указывают на преимущества этого метода для оценки дисфункции тазового дна. Цель исследования — сравнение обычной и магнитно-резонансной дефекографии у пациентов с синдромом обструкции прямой кишки. Материалы и методы. Двадцать восемь пациентов, страдающих запорами, с января 2015 г. по январь 2020 г. были включены в исследование. Магнитно-резонансная дефекография проводилась через 1–2 недели после обычной дефекографии. Осуществляли сравнительный анализ методов относительно их способности диагностировать патологическое выпячивание передней или задней стенки прямой кишки, нарушающее эвакуаторную функцию кишечника, ректальный пролапс, прямокишечную грыжу, дивертикул прямой кишки. Результаты. Сравнение обычной и магнитно-резонансной дефекографии по их способности диагностировать переднее ректоцеле, инвагинацию внутренней слизистой оболочки и спазм прямой кишки не подтверждает существенных различий между двумя методами. Статистический коэффициент использования двух методов диагностики переднего ректоцеле, инвагинации внутренней слизистой оболочки и спазмов прямой кишки составил соответственно 0,146, 0,007 и 1000. Выводы. Хотя обычная дефекография является золотым стандартом для диагностики ректоцеле, инвагинации внутренней слизистой оболочки и пуборектального спазма, магнитно-резонансная дефекография обладает преимуществами благодаря меньшей радиационной нагрузке, повышенной безопасности и возможности выявления патологии репродуктивной сферы.

Clinical, endoscopic and radiological assessment of patients with obstructed defecation: findings and management at a District General Hospital

Background: The aim of the study was to determine the diagnostic value of clinical, endoscopic and proctographic assessment as well as clinical outcomes in patients with obstructed defaecation (OD). The study also examined correlation between clinical/endoscopic findings and proctogram in the diagnosis of rectocele and intra-rectal intussusception (IRI).Methods: Patients presenting with symptoms of OD between January-December 2018 were assessed with manual examination, endoscopy and defecation proctogram. Patients were followed for 2-3 years for clinical outcomes.Results: There were 65 female (97.01%) and 2 male patients (2.98%), with an average age of 57.77 (34-88) years. Main indications were OD, altered bowels, faecal urgency and rectal bleeding. A total of 67 X-ray defecating proctograms and 77 endoscopies were performed. Main findings on clinico-endoscopic examination were IRI (44), rectocele (36) and haemorrhoids (21). Main findings on proctogram were rectocele (59), IRI (56) and enterocele (13). Endoscopic assessment showed sensitivity: 55.93%, specificity: 62.50% and accuracy: 56.72% in diagnosing rectocele when compared with the diagnostic confirmation on proctogram. Combining manual assessment with endoscopic findings improved sensitivity (76.27%) and accuracy (68.66%). Similar improvement was also noted in the sensitivity (61.40 to 66.67%), specificity (47 to 58%), and accuracy (53.73 to 58.21%) in diagnosing IRI when compared with the diagnostic confirmation on proctogram. Majority of the patients improved with conservative measures; however, surgical intervention was required in 13 patients.Conclusions: Although manual examination enhances endoscopic assessment in diagnosing rectocele and IRI, proctogram is still required for objective assessment. Management of OD remains mainly conservative, with surgical intervention required in some patients.

Is the transperineal ultrasonography approach effective for the diagnosis of rectocele?

BackgroundTransperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory. This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.MethodsIn this pilot study, participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019. All participants separately underwent defecation proctography at sitting and squatting positions, and undertook transperineal ultrasonography at left lateral, sitting, and squatting positions. The consistency of ultrasonography and defecography was evaluated.ResultsThirty female volunteers with rectocele were included in this study. The degree of anorectal angle was significantly larger at rest and during contraction, maximal Valsalva, and evacuation; the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation; and the length of the perineum descending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography. The degree of anorectal angle, the depth of rectocele, the area of levator hiatus, and the volume of the rectocele were significantly different in using squatting, sitting, and left lateral positions when performing the transperineal ultrasonography. Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.ConclusionsThe findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.

Temporary successful results of ventral rectopexy for enterocele surgical correction, about 138 patients.

This work aimed to analyse short- and long-term results of enterocele surgical treatment by ventral rectopexy. All females who underwent ventral rectopexy for enterocele in our department were included. All patients underwent standardized preoperative evaluation. Data was retrospectively collected, after examination of patients or by telephone survey. Postoperative evaluation was performed by an independent observer. One hundred thirty-eight females (median age=63years [21-86years]) were included. They were postmenopausal and multiparous in 94 and 70% of cases, respectively. Pelvic pressure, vaginal prolapse, or the both were observed in 28, 16 or 56% of the patients, respectively. The most frequent associated symptoms were dyschezia (63%) and faecal incontinence (30%). On preoperative workup, enterocele was isolated in two cases. Rectocele, internal rectal prolapse and cervicocystoptosis were the most frequently associated pelvic floor disorders. Ventral rectopexy was performed through laparoscopy in 128 patients (93%). In the short term, all pelvic symptoms were significantly improved, except urinary incontinence. At the end of follow-up (56months [7-125]), specific symptoms and dyschezia were still significantly improved. Secondary failure was reported in 31% of patients. By multivariate analysis, two predictive factors for long-term failure were found: diagnosis of rectocele on preoperative MRI (odd ratio=15; 95% CI 1.4-163; p=0.03) and conversion into open surgery (odd ratio=8; 95% CI 1.4-43; p=0.02). This study suggests that ventral rectopexy is an effective treatment of enterocele, but secondary failure can be observed. Patients should be informed of the potential risk of long-term degradation.

Rectocele : Symptoms, diagnostics and therapy concepts from a coloproctological viewpoint

Anterior rectocele is acommon morphological condition in patients with obstructive defecation syndrome. Typical symptoms include incomplete evacuation, transanal or transvaginal digitation and soiling, which is frequently interpreted as fecal incontinence. Diagnosis of rectocele is made clinically and functional assessment of rectocele can be performed by dynamic imaging, e.g. by magnetic resonance (MR) defecography. Primary treatment should be conservative. Concerning surgical treatment, transanal, transperineal, transvaginal and transabdominal procedures are available. Evidence-based guidelines for surgical treatment are still lacking. The question whether rectocele is acause or a consequence of obstructive defecation syndrome remains controversial. Accordingly, indications for surgical correction of rectocele should be considered with caution.

Effects of dynamic transperineal ultrasound and dynamic magnetic resonance imaging defecography in the diagnosis of rectocele

Objective To evaluate the agreement between dynamic transperineal ultrasound (DTP-US)and dynamic magnetic resonance imaging defecography (DMRD) in the diagnosis of rectocele,and to compare the correlation and difference between the depth of rectocele measured by DTP-US and DMRD.Methods The clinical data of 18 female patients with rectocele who were admitted to the Third Affiliated Hospital of Nanjing University of Chinese Medicine from September 2011 to May 2012 were retrospectively analyzed.All patients received examination via DTP-US and DMRD,and the agreement of the 2 diagnosing methods was analysed.The accurate rates of the detection of other pelvic floor abnormalities by the 2 methods were calculated.The agreement of DTP-US and DMRD in diagnosing rectocele was analysed by Cohen's kappa test.The difference of the depth of rectocele measured by DTP-US and DMRD was compared by paired samplet test,and the correlation of the depth of rectocele measured by DTP-US and DMRD was analyzed by using the Pearson correlation coefficient.Results Of the 14 patients diagnosed by DTP-US,there were 7 patients with bladder prolapse,5 with unrelaxed pelvic floor,2 with uterine prolapse,2 with rectal internal mucous intussusception and 1 with enterocele; of the 18 patients diagnosed by DMRD,there were 12 patients with bladder prolapse,8 with unrelaxed pelvic floor,8 with uterine prolapse,6 with rectal internal mucous intussusception and 1 with enterocele.The agreement coefficient between DTP-US and DMRD in diagnosing rectocele was obvious (κ =0.737,P ＜ 0.05).The depth of the rectocele detected by DTP-US and DMRD were (15 ±6)mm (range,7-24 mm) and (27 ±7)mm (range,20-41 mm),with significant difference between the 2 groups (t =-16.124,P ＜0.05).There was a high coefficient between DTP-US and DMRD in detecting the depth of rectocele (| r | =0.874,P ＜ 0.05).The depth of rectocele detected by DMRD increased as the increase of depth of rectocele detected by DTP-US (| r | =1.000,P ＜ 0.05).Conclusions The agreement between DTP-US and DMRD in diagnosing rectocele is high.The depth of rectocele measured by the 2 methods not only has statistically significance,but also exists a high degree of correlation.While DTP-US is superior to DMRD in terms of quick diagnosis and better telerance of patients. Key words: Rectocele; Dynamic transperineal ultrasound; Dynamic magnetic resonance imaging defecography ; Constipation ; Outlet obstruction constipation

The role of hemorrhoidectomy in rectocele complicated by grade 3–4 hemorrhoids

We read with great interest the article by Leal et al. [1] in which the authors concluded that the transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS procedure) has satisfactory anatomic and functional results with a low incidence of postoperative pain and complications. A rectocele is an abnormal sac-like projection of the anterior rectum into the posterior vaginal wall. Women commonly complain of stool trapping, a form of obstructed defecation, and report requiring digital pressure through the vagina in order to pass stools. The diagnosis of rectocele can be easily made on rectal examination. Defecography can be used for diagnosis or surgical decision making [2]. Stool trapping requiring digital evacuation or vaginal support and large protruding rectoceles are the major criteria for operative intervention [3]. Rectocele can be treated with a variety of local surgical approaches including the technique used by authors for rectocele complicated by rectal mucosal prolapse. Rectocele can be complicated by other perianal pathologies like hemorrhoids. We would like to share our experience of patients with grade 3 and 4 hemorrhoids coexisting with symptomatic rectocele. Eight women presented with some complaint of stool trapping, constipation, anal swelling and bright red blood per rectum. Rectocele and grade 3–4 hemorrhoids were diagnosed based on the history, physical examination, colonoscopy and defecography. We planned a 3-quadrant hemorrhoidectomy with Liga-Sure as an initial treatment. After recovery, we saw that symptoms related to rectocele were improved in all of the patients, and defecography was normal. Postsurgical inflammation and fibrosis in 3-quadrant hemorrhoidectomy may increase the tightness in the anal mucosa and prevent bulging into the vagina. We think that a 3-quadrant hemorrhoidectomy rather than a circular mucosectomy causes more tightness in anal canal mucosa and better recovery for patients with coexisting rectocele.

Tu2015 Is Trapping of Balloon in Rectocele During Rectal Manometry Predictive of Defecography Results?

Background: A rectocele is an out pouching of the anterior rectal wall into the lumen of the vagina. The definition, etiology, and pathophysiology of rectoceles are not fully understood. Although obstetric trauma and defecatory disorders have been implicated, a rectocele has been identified in both asymptomatic and nulliparous women. The current gold standard to assess if the rectocele contributes to difficulties in defecation is defecography. The role of balloon expulsion test in assessing rectocele was never defined. Aim: To assess the role of balloon expulsion test in patients with known rectocele who underwent defecography Methods: Retrospective analysis of all patients' data that underwent defecography in DDI in Shaare Zedek Medical center since March 2011. Patients with diagnosis of rectocele who also underwent a rectal manometry were recruited. Demographic and clinical characteristics' of the study population were recorded. Results: Eleven of 26 patients fulfilled the selection criteria. All patients were women with mean age of 60±12 years (38-75). Contrast capture in rectocele during defecography was recorded in 8 patients. Balloon trapping in rectocele during rectal manometry was detected in 6 patients. All of these 6 patients failed to expel the balloon during manometry. The sensitivity, specificity, PPV and NPV of Balloon trapping during manometry was 75%, 100%, 100% and 40% respectively. Conclusions: Trapping of balloon in rectocele during rectal manometry can predict pathologic results in defecography. Further study is needed in order to validate the procedure's role in diagnosis in decision making while managing such patients.

Significance of defecography and the role of rectocele in constipated patients

Backround: Chronic constipation is a common, chronic and frequent problem of the general population. The aim of this study is to assess the efficacy of defecography in diagnosing the etiology of constipation and the relation between constipation and rectocele. Material-method: We have investigated 250 patients who have been admitted to our general surgery out-patient clinic with complaint of constipation using Rome III criteria and diagnostic defecography. Results: Out of 250 patients who were evaluated with defecography only 24 had normal findings. 136 patients were found to have rectocele. Conclusion: We propose that rectocele is an important etiology of constipation, and defecography should be considered early in the diagnosis of rectocele.

MR rectography evaluation of rectoceles with oral gadopentetate dimeglumine and polyethylene glycol solution.

We assessed the value of magnetic resonance (MR) rectography in diagnosing rectocele by using a combination of oral gadopentetate dimeglumine and polyethylene glycol solutions. T1-weighted, breath-hold, fast low-angle shot sequences were made in 22 patients in resting and straining states in the supine position before and after administration of oral paramagnetic contrast. Twelve patients received polyethylene glycol solution in addition to contrast, and 10 received contrast only. The pubococcygeal line was the reference used for diagnostic measurements. The quality of each sequence was graded. Paired t test, chi-square test, and the Kolmogorov-Smirnov test were applied for statistical analysis. The results of noncontrast images were inconclusive. There was a statistically significant difference between MR imaging diagnosis of rectocele in patients in the straining position without and with contrast ( p < 0.05), and the difference was more prominent in patients using polyethylene glycol solution ( p < 0.001). Using oral contrast plus polyethylene glycol produced significantly better MR examinations in the resting and straining positions ( p < 0.05). The combination of oral contrast and polyethylene glycol solution improves the diagnostic value of MR rectography and is particularly useful when noncontrast examinations are inconclusive.

Associations of defecography and physiologic findings in male patients with rectocele.

This study evaluated the incidence and physiological findings in male patients with rectoceles. All defecographic studies were evaluated by a single colorectal surgeon. After diagnosis of rectocele in male patients, the patient's history, symptoms, and physiologic tests (anal manometry, pudendal nerve terminal motor latency [PNTML], assessment and electromyography [EMG]) were studied. A prominent rectocele was defined as one that did not empty during defecography and was associated with outlet obstructive syndrome. Forty (17%) rectoceles were diagnosed in 234 male patients with evacuatory disorders who underwent defecography. Rectoceles were anterior in 19 (48%) and posterior in 21 (52%) patients. The main complaint was constipation with difficult defecation in 33 (83%), followed by rectal pain in 5 (13%), rectal prolapse in 1 (3%), and incontinence in 1 (3%). Previous prostatic surgery had been performed in 16 (40%) patients. The mean age and duration of symptoms were 72.4 years (range, 30-88) and 10.3 years (range, 0.5-70), respectively. Excessive straining during evacuation was noted in 73%, unilateral or bilateral pudendal neuropathy in 24.5%, paradoxical puborectalis contraction in 49% and abnormal EMG in 11% of patients. Higher resting pressures with a mean 3.9 cm high pressure zone were noted in 29% of patients. The accompanying findings in defecography were, non-relaxing or partially relaxing puborectalis muscle (66%), perineal descent (65%), intussusception (23%), and sigmoidocele (15%). None of the patients underwent surgery for rectocele alone. In conclusion, rectocele is uncommon in males; it rarely appears as an isolated dysfunction as it is often associated with functional disorders of the pelvic floor. There is a frequent association between rectocele and prostatectomy. Clinical significance and therapeutic strategy remain unknown.