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Laparoscopic Rectopexy for Rectal Prolapse
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Jitender Singh Chauhan
Defecography: Not useful in external rectal prolapse; nevertheless imaging is useful in patients for whom the prolapse cannot be reproduced on physical examination, or when symptoms are present suggestive of additional pelvic floor disorders [21,22]. Defecography, either via traditional fluoroscopy or dynamic magnetic resonance imaging (MRI), can reveal defects associated with rectal prolapse in up to 80% of patients with obstructive defecation symptoms [23].
Chronic Idiopathic Constipation
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Defecography is a technique in which barium thickened to a consistency approximating stool is introduced into the rectum (11). Evacuation of the barium can be monitored by fluoroscopy or videotape while the patient sits on a specially constructed commode. Assessment of the anorectal structures, including the anorectal angle, are obtained at rest and during expulsion of the barium mixture. Anatomical abnormalities such as rectoceles and intussusceptions may also be apparent during straining. However, as there is great variability among radiologists with respect to interpreting these studies, more experience with this technique is needed before dicisions can be made with confidence on the basis of radiographic findings.
Soiling
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
R. J. F. Felt-Bersma, M. A. Cuesta
In conclusion, soiling is characterized by liquid discharge of the anus or perianal area, caused by conditions easily diagnosed by simple means of inspection and proctoscopy. Anorectal function tests do not show important abnormalities, except in patients with rectal prolapse or extensive (peri)anal scarring, and do not contribute to establishing a diagnosis. Defecography and endosonography are indicated when no initial diagnosis can be made. In most cases appropriate treatment is available.
Surgical decision-making for rectal prolapse: one size does not fit all
Published in Postgraduate Medicine, 2020
Angela Lee, Cindy Kin, Raveen Syan, Arden Morris, Brooke Gurland
Following IRB approval, a study cohort was identified from patients at a single tertiary pelvic health center between July 2017 and November 2018, based on the diagnosis of rectal prolapse as made by clinical exam, photograph or diagnostic imaging. All patients with the diagnosis of high-grade internal rectal prolapse underwent fluoroscopic or magnetic resonance defecography. Only patients with external (Oxford grade V) or intra-anal high Oxford grade III or IV internal rectal prolapse were included in the registry [13–15]. We excluded patients with limited mucosal or hemorrhoidal prolapse. Patients with concomitant anterior and middle compartment prolapse, e.g. concomitant vaginal prolapse and urinary dysfunction, were referred for gynecological examination and treatment as part of a multidisciplinary pelvic health center. Patients either being considered for or undergoing concomitant repair were included in this study.
Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Megan R. Routzong, Ghazaleh Rostaminia, Shaniel T. Bowen, Roger P. Goldberg, Steven D. Abramowitch
This study employed MR defecography to evaluate the relationship between midsagittal pelvic floor anatomy and ODS during defecation. The goal was to identify the changes in pelvic floor shape that occur during evacuation and differences between control (without pelvic constipation) vs case (those with ODS presenting as pelvic constipation without dyssynergia) subjects using statistical shape modelling to ensure that findings would not be limited to specific anatomical landmarks and established clinical measurements. We hypothesized that pelvic floor shape would be affected significantly (p < 0.05) by State (rest vs peak evacuation) and Group (control vs case).
Investigation of pelvic floor disorders
Published in Climacteric, 2019
MRI has also been used for the investigation of patients with defecatory dysfunction and fecal incontinence. More specifically, magnetic resonance defecography has an important role in the investigation of conditions of the posterior compartment that are difficult to be diagnosed by a simple clinical examination52. Magnetic resonance defecography may differentiate conditions such as anterior/posterior rectocele, enterocele, rectal mucosal intussusception, and rectal full-thickness intussusception, thus allowing the clinician to plan the appropriate medical or surgical treatment.