Carrillo MMÁ, Ávila AJA, Martínez MA, Sánchez ÁMT, Morales GLA, Elizondo VTC

Language: Spanish
References: 22
Page: 247-257
PDF size: 212.42 Kb.

ABSTRACT

Introduction. Defecography is a study that provides functional and structural information on the anorectal region. Patients with defecatory disorders, such as fecal incontinence and constipation, are difficult to diagnose and treat. Defecography may help in evaluating such patients, both in detecting anatomical abnormalities and possible causes of such disorders and as an anatomical guide if surgical correction proves necessary.
Purpose. The purpose of this article is to review the anatomy of the pelvic floor and the physiology of defecation, describe the technique of defecography and radiological diagnosis of defecatory disorders and prolapse of the pelvic organs, and finally to report the experience of Hospital San Jose Tec de Monterrey with this radiological technique. Material and methods. Three hundred and thirty-one defecatory studies performed in patients at Hospital San Jose Tec de Monterrey, from 1996 to 2010, were retrospectively analyzed. Two hundred and ninety-one women and 40 men were included, with ages ranging from 4 to 80 years (average age 41.03 years). Aperture of the anal canal, relaxation of the puborectalis muscle, evacuation of contrast medium, pelvic floor descent, mucosal procidentia, and rectal prolapse were evaluated.
Results. All the defecographies revealed some abnormality. Two hundred and eighty-eight anterior rectoceles, 21 posterior rectoceles, as well as 140 cases of invagination, 99 of pelvic floor descent, 40 of enterocele, and 37 of mucosal procidentia and prolapse were identified, and other anomalies such as 1 ulcer (0.15%), 1 megarectum (0.15%), and 1 incontinence (0.15%).
Conclusion. Today defecography plays a very important role in evaluation of patients with constipation and has influenced the choice of different treatment options.

REFERENCES

1. Ikenberry S, Lappas S, Hanna M, Rex D. Defecography In healthy subjects: Comparison of three contrast media. Radiology 1996;201:233-238.

2. Goei R. Anorectal function in patients with defecation disorders and asymptomatic subjects: Evaluation with defecography. Radiology 1990;174:121- 123.

3. Harvey C, Halligan S, Bartram C, Hollings N, Sahdev A, Kingston K. Evacuation proctography: A prospective study of diagnostic and therapeutic effects. Radiology 1999;211:223-227.

4. Mahieu P, Pringot J, Bodart P. Defecography. I. Description of a new procedure and results in normal patients. Gastrointest Radiol 1984;9:247–251.

5. Karasick S, Karasick D, Karasick S. Functional disorders of the anus and rectum: Findings on defecography, Pictorial Essay. AJR 1993;160:777-782.

6. Stoker J, Halligan S, Bartram C. State of the art, Pelvic floor imaging. Radiology 2001;218:621-641.

7. Savoye-Collete C, Koning E y Dacher J. Radiologic evaluation of pelvic floor disorder. Gastroenterol Clin N Am 2008;37:553-567.

8. Ekberg O, Nylander G. Defecography. Radiology 1985;155:45-48.

9. Gimeno F. La defecografía en el estudio del compartimento posterior del suelo de la pelvis en mujeres con prolapso genital. Universitat de Barcelona Falcutat de Medicina Departamento d’obstetricia, ginecología, pediatría, radiología y medicina física._________. 1-137.

10. Goei R, Engelshoven J, Schouten H. Anorectal function: Defecographic measurements of in asymptomatic subjects. Radiology 1989;173:137-141.

11. Halligan S, Malour A, Bartram C, Marshal M. Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR 2001;177:633-636.

12. Pomerri F, Zuliani M, Mazza C, Vilarejo, Scopece A. Defecographic measurments of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR 2001;176:641-645.

13. Maglinte D, Bartram C, Hale D, Park J et al. Functional imaging of the pelvic floor. Radiology 2011;258:23-39.

14. Goei R, Baeten C, Arends J. Solitary rectal ulcer syndrome: Findings at barium enema and defecography. Radiology 1988;168:303-306.

15. Goei R, Baeten C. Rectal intussusceptions and rectal prolapsed: Detection and postoperative evaluation with defecography. Radiology 1990;171:124- 126.

16. Bernier P, Stevenson G, Shorvon P. Defecography commode. Radiology 1988; 166:891-892.6

17. Lessafer L. Defecography-Update 1994, Book Review. Radiology 1997;692.

18. Kelvin F, Maglinte D, Hornback J, Benson J. Pelvic prolapsed: Assessment with evacuation proctography (Defecography). Radiology 1992;184:547- 551.

19. Karlbom U, Nilsson S, Pahlman L, Graf W. Defecography Study of rectal evacuation in constipated patients and control subjects. Radiology 1999;210:103-108.

20. Alfisher M, Scholz F, Roberts P, Couniban T. Radiology of ileal pouch-anal anastomosis: Normal findings, examination pitfalls, and complications. Radiographics 1997;17:81-98.

21. Dobben A, Wiersma T, Janssen L. Prospective assessment of interobserver agreement for defecography in fecal incontinence. AJR 2005;185:1166-1172.

22. Marrufo C, Sánchez M, Morales L. Manometría y defecografía en pacientes constipados con disquecia. Rev Gastroenterol Mex 2005;70(4):424-429.