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Biomedical subjects

A Mellgren

Publications and source records attributed to A Mellgren.

At least 37 records · Page 2Linked to original sources
PubMed1998

Paradoxical sphincter reaction is influenced by rectal filling volume.

PURPOSE: Paradoxical sphincter reaction is frequently found in constipated patients but sometimes also in incontinent patients and in asymptomatic subjects. Its significance in defecation disorders has, therefore, been debated. The aim of the present study was to investigate whether paradoxical sphincter reaction is influenced by rectal filling volume. PATIENTS AND METHODS: Eighteen patients with defecation disorders and paradoxical sphincter reaction shown by electromyography were reinvestigated with an extended electromyographic investigation while in the lying position and while in the sitting position, with 50-ml, 100-ml, and 150-ml water-filled rectal balloons. RESULTS: All 18 patients showing paradoxical sphincter reaction in the first investigation also showed the reaction at the second investigation in the lying position with a 0-ml volume of rectal contents. In the sitting position, with a volume of 150 ml of rectal contents, the increase in electromyographic activity disappeared in seven patients (39 percent) and no longer showed paradoxical sphincter reaction. Electromyography showed decreased activity in one patient and unchanged activity in six patients during straining. A closing reflex was seen after completed straining in all of these seven patients. CONCLUSIONS: The present study demonstrates that paradoxical sphincter reaction diagnosed by electromyography is influenced by the rectal filling volume and might diminish when the rectum is filled with contents. The conventional electrophysiologic technique in the diagnosis of paradoxical sphincter reaction might, therefore, overdiagnose this condition.

Adult↗
PubMed1998

Rectocele is associated with paradoxical anal sphincter reaction.

Rectocele is a frequent finding in constipated patients. However, constipation is not always relieved by rectocele repair, which may be due to other overlooked reasons for constipation. The study was designed to investigate patients with rectocele, in order to elucidate concomitant colorectal disorders and their association with rectocele. One hundred and twelve female patients suffering from severe constipation and rectal emptying difficulties were investigated using defecography, electrophysiology, anorectal manometry and colon transit time. Fifty-six patients with rectocele demonstrated by defecography were compared with 56 patients without rectocele, but with other abnormal findings at defecography. The frequency of paradoxical anal sphincter reaction (PSR) was higher in patients with rectocele (60%) than in patients without rectocele (24%). The present study supports an association between rectocele and PSR. We suggest that constipated patients with a rectocele should be investigated thoroughly before rectocele repair is considered. Further studies on the effect of biofeedback training in patients with rectocele and PSR are indicated.

Adult↗
PubMed1998

Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography.

PURPOSE: To study, by means of defaeco-peritoneography, the formation and transformation of the peritoneocele, with and without an enterocele, during rectal evacuation. MATERIAL AND METHODS: Forty-six patients with a peritoneocele at defaeco-peritoneography were selected for the study, and examined at three different stages: 1) at the start with a contrast-filled rectum; 2) at maximum straining; and 3) at rest after rectal evacuation. RESULTS: Fourteen patients had a peritoneocele at the start. These peritoneoceles were largest at maximum straining and were all still present at rest after rectal evacuation. In 32 patients defaeco-peritoneography was regarded as normal at the start. At maximum straining these patients developed a peritoneocele and 20 of these were still present after rectal evacuation. No enterocele was seen at the start. At maximum straining 21 patients developed an enterocele and 15 of these were still present after rectal evacuation. Liquid in varying amounts was found in the peritoneoceles. CONCLUSION: The present study demonstrated that peritoneoceles were present at different stages of the defaeco-peritoneographic investigations. Peritoneoceles were most frequent and largest at maximum straining. An enterocele was present in half of the peritoneoceles at maximum straining, but never at the start. Liquid was often present in the peritoneoceles.

Adult↗
PubMed1997

Internal rectal intussusception seldom develops into total rectal prolapse.

PURPOSE: This study was designed to analyze how often internal rectal intussusception develops into total rectal prolapse. METHODS: Repeated investigations with defecography were performed in 312 patients because of persisting symptoms. In 79 patients who had a rectal intussusception at the first defecography, results of the second defecography and the patients' records were studied. RESULTS: A total of 38 patients had not undergone any surgical treatment of rectal intussusception or rectal prolapse between the first and second defecographies. One of these patients had a rectal prolapse at the second defecography, and another developed a clinical prolapse after the second defecography. CONCLUSIONS: The present study demonstrates that the risk of developing a rectal prolapse in patients with rectal intussusception is small. This risk should, therefore, not be used as an indication for surgery.

Administration, Oral↗
PubMed1997

Pelvic anatomy and pathology is influenced by distention of the rectum: defecoperitoneography before and after rectal filling with contrast medium.

PURPOSE: The aim of the present study was to evaluate how distention of the rectum with contrast medium at defecoperitoneography affected pelvic anatomy, i.e., position, form, and size, of organs and pouch of Douglas. PATIENTS AND METHODS: Twenty-six female patients with a peritoneocele at defecoperitoneography were selected for the present study. Radiographs taken at the start, before, and after filling the rectum with contrast medium were compared. RESULTS: There was an obvious change in the position of the organs in the pelvis when the rectum was distended with contrast medium. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7 patients, and the enterocele disappeared completely in 13 patients. The small bowel and vaginal portion of the uterus moved cranially. CONCLUSIONS: A distended rectum may conceal existing pathology, such as peritoneocele and enterocele, at defecoperitoneography. Defecoperitoneography should, therefore, include a radiograph before the rectum is filled. This radiograph shows the habitual anatomy of the patient in the sitting position and may demonstrate pathologic findings.

Adult↗
PubMed1997

Defaeco-peritoneography in the diagnosis of rectal intussusception and rectal prolapse.

PURPOSE: The aim of the present study was to evaluate the use of defaeco-peritoneography in diagnosing rectal intussusception as distinct from mucosal folds in the rectum, and rectal prolapse as distinct from mucosal prolapse. MATERIAL AND METHODS: Fifty-seven patients with defaecation disorders were examined by means of defaeco-peritoneography. RESULTS: Twenty-three patients had rectal intussusception and 7 patients had rectal prolapse at defaeco-peritoneography. All these patients had a rectal peritoneocele in the serosal ring-pocket of the rectal intussusception or in the rectal prolapse. Twenty-seven patients had neither rectal intussusception nor rectal prolapse and none of these patients had a rectal peritoneocele. CONCLUSION: The present study demonstrated that only patients with a rectal intussusception or rectal prolapse have a rectal peritoneocele. Defaeco-peritoneography therefore offers correct diagnosis of rectal intussusception as distinct from mucosal folds in the rectum, and of rectal prolapse as distinct from mucosal prolapse.

Barium Sulfate↗
PubMed1997

Peritoneocele: visualization with defecography and peritoneography performed simultaneously.

PURPOSE: To evaluate the use of simultaneous defecography and peritoneography (defecoperitoneography) in patients with an unexplained widening of the rectovaginal space noted at defecography. MATERIALS AND METHODS: Twenty-two patients with unexplained widening of the rectovaginal space noted at defecography were studied with defecoperitoneography. Defecoperitoneography was a combination of defecography and peritoneography with water-soluble contrast medium administered intraperitoneally. RESULTS: The outline and movements of the peritoneum and alterations in the pelvic peritoneal cavity could be visualized with defecoperitoneography during the dynamic act of defecation. Unexplained widening of the rectovaginal space was completely due to a peritoneocele in 14 patients and partially due to a peritoneocele in six patients. In two patients, there was no peritoneocele. Only nine of 22 patients had bowel in the unexplained widening (enterocele). Three patients had a rectal peritoneocele; six, a septal peritoneocele; one, a vaginal peritoneocele; and 10, a combination of these findings. CONCLUSION: Visualization of the pelvic floor with defecoperitoneography is improved compared with visualization with defecography alone.

Adult↗
PubMed1996

Continence is improved after the Ripstein rectopexy. Different mechanizms in rectal prolapse and rectal intussusception?

PURPOSE: This study was undertaken to evaluate anal manometric changes after Ripstein's operation for rectal prolapse and rectal intussusception and to study the clinical outcome following the operation, with special reference to anal incontinence. METHODS: Forty-two patients with rectal prolapse or rectal intussusception were subjected to anorectal manometry preoperatively and seven days and six months postoperatively. A detailed history was obtained from each patient preoperatively and six months postoperatively. RESULTS: Preoperatively, patients with rectal intussusception had higher maximum resting pressure (MRP) (52+/- 23 mmHg) than patients with rectal prolapse (34 +/- 20 mmHg; P < 0.01). In the group of patients with rectal prolapse, there was a postoperative increase in MRP after six months (P < 0.001) but not after seven days. Maximum squeeze pressure (MSP) did not increase. Neither MRP nor MSP increased postoperatively in patients with internal rectal procidentia. Continence was improved postoperatively both in patients with rectal prolapse (P < 0.01) and rectal intussusception (P < 0.01). There was no postoperative increase in rectal emptying difficulties. CONCLUSION: Ripstein's operation often improved anal continence in patients with rectal prolapse and rectal intussusception. This improvement was accompanied by increased MRP in patients with rectal prolapse, indicating recovery of internal anal sphincter function. No postoperative increase in MRP was found in patinets with rectal intussusception. This suggests an alternate mechanism of improvement in patients with rectal intussusception.

Adult↗
PubMed1995

Simultaneous defecography and peritoneography in defecation disorders.

UNLABELLED: A number of physiologic and radiologic investigations are used in investigating defecation disorders. Defecography is one important part of these investigations. However, a correct diagnosis of an enterocele is sometimes difficult despite use of contrast media in the rectum, vagina, and small bowel. PURPOSE: This study was undertaken to ascertain if it was technically possible to perform simultaneous defecography and peritoneography in an effort to improve the diagnostic possibilities in patients with defecation disorders. METHODS: Twelve patients with defecation disorders and an unexplained widening of the rectovaginal space at defecography were investigated. Contrast medium was introduced intraperitoneally, after which conventional defecography was performed. RESULTS: All investigations were carried out without complications and demonstrated the peritoneal outline in all patients. Simultaneous defecography and peritoneography differentiated between an enterocele and a pathologically deep pouch of Douglas--a peritoneocele. Three types of peritoneocele were visualized: vaginal peritoneocele, septal peritoneocele, and rectal peritoneocele with or without enterocele. Combinations of the three types were also found. Eight of the 12 patients had rectal intussusception or rectal prolapse. All of these eight patients had a rectal peritoneocele. CONCLUSIONS: Simultaneous defecography and peritoneography can be performed without technical difficulties or complications. Peritoneal outlines and pouches can, therefore, be studied directly during the act of defecation. An unexplained widening of the rectovaginal space at defecography can be clarified as a peritoneocele, with or without an enterocele. Peritoneocele can be of three different types: rectal, septal, or vaginal.

Aged↗
PubMed1995

Results of rectocele repair. A prospective study.

PURPOSE: This study was designed to evaluate the results of rectocele repair and parameters that might be useful in selecting patients for this operation. METHODS: Twenty-five patients with symptom-giving rectoceles were prospectively evaluated with a standardized questionnaire, physical examination, defecography, colon transit studies, anorectal manometry, and electrophysiology. Patients underwent posterior colporrhaphy and perineorrhaphy. They were followed postoperatively (mean, 1.0 year) with the same questionnaire, physical examination, defecography, anorectal manometry, and electrophysiology. RESULTS: Constipation had improved postoperatively in 21 of 24 constipated patients (88 percent). At postoperative follow-up 13 patients (52 percent) had no constipation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 percent) had symptoms more than once per week. Four patients with rectocele at preoperative defecography, but not at physical examination, had favorable outcomes following surgery. The majority of patients not using vaginal digitalization preoperatively had improved with respect to constipation. All patients with pathologic transit studies had various degrees of constipation postoperatively. Constipation was not improved in two of five patients with preoperative paradoxic sphincter reaction. CONCLUSIONS: Rectocele is one cause of constipation that can be treated with good results. Preoperative use of vaginal digitalization is not mandatory for a good postoperative result. Defecography is an important complement to physical examination. Patients with pathologic transit study might have a less favorable outcome of rectocele repair with respect to constipation. More studies about the significance of paradoxic sphincter reaction in these patients are indicated.

Adult↗
PubMed1994

Enterocele demonstrated by defaecography is associated with other pelvic floor disorders.

Sixty-nine patients with enterocele on defaecography, and 128 patients without enterocele but with other abnormal findings were investigated to identify concomitant colorectal disorders and their relationship with enterocele. Of the 69 patients with enterocele, 38 (55%) had concomitant rectal intususception and 26 (38%) rectal prolapse. Abnormal physiological findings on anorectal manometry and electrophysiology were more common in patients with enterocele. Previous hysterectomy increased the risk of enterocele formation. The study has demonstrated that patients with enterocele should be investigated thoroughly for other lesions before treatment is planned. Further investigation of the role of enterocele in patients with defaecation disorders is required.

Adolescent↗
PubMed1994

Defecography. Results of investigations in 2,816 patients.

PURPOSE: This study was designed to analyze the frequency of different findings at defecography in patients with defecation disorders and see in what way the evaluation could be improved. METHODS: The reports of investigations in 2,816 patients were analyzed. RESULTS: Twenty-three percent of the investigations were considered normal. Thirty-one percent of the patients had rectal intussusception, 13 percent had rectal prolapse, 27 percent had rectocele, and 19 percent had enterocele. Twenty-one percent of the patients had a combination of two or three of these diagnoses. The combination of rectocele and enterocele was rare. The majority of patients with enterocele had other concomitant findings. Patients with or without abnormal perineal descent had similar frequencies of rectal prolapse, rectal intussusception, and enterocele. Rectocele was more common in patients with abnormal perineal descent. CONCLUSIONS: Defecography is valuable when investigating patients with defecation disorders. Pathologic findings were found in 77 percent of the patients. A standardized protocol should ensure a complete evaluation of defecography.

Adolescent↗
PubMed1994

Enterocele is correctable using the Ripstein rectopexy.

PURPOSE: About one-third of the patients with rectal prolapse or rectal intussusception have concurrent enterocele at defecography. The purpose of this study was to evaluate the effect of the Ripstein procedure on the concurrent enterocele and to study the outcome of the procedure with respect to the patients' symptoms. METHODS: Twenty-two patients with enterocele and either rectal prolapse or rectal intussusception at defecography were treated using the Ripstein procedure. Postoperatively, the patients were evaluated with clinical examination (22 patients) and defecography (16 patients). RESULTS: None of the patients had recurrence of enterocele, rectal prolapse, or intussusception at postoperative follow-up. Continence was improved in 15 of 16 incontinent patients. Emptying difficulties were unchanged in eight patients, improved in five patients, and had deteriorated in four patients. CONCLUSIONS: Enterocele is corrected by using the Ripstein rectopexy. Persisting defecation difficulties after the Ripstein procedure are unlikely to be secondary to enterocele. The Ripstein procedure can be an alternative in the treatment of enterocele, as a majority of these patients also have rectal prolapse or rectal intussusception.

Defecation↗
PubMed1992

Paradoxical sphincter reaction and associated colorectal disorders.

Of 71 patients with paradoxical sphincter reaction, 54 had symptoms of constipation or outlet obstruction and 17 were incontinent. The patients were investigated with defecography, colon transit time, anorectal manometry and electromyography. Ninety-six percent of the patients had additional changes in anorectal anatomy and physiology; 70% of the patients had abnormal defecography and 42% had delayed colon transit time. Decreased maximal anal pressure (MAP) and maximal squeeze pressure (MSP), indicating impaired function of the anal sphincters might be one reason for incontinence in patients with paradoxical sphincter reaction. The paradoxical reaction occurred in the puborectalis muscle and in three tested sites in the external sphincter. It is sufficient to record the EMG activity in one muscle and at one point to diagnose a paradoxical sphincter reaction. The absence of a normal closing reflex on electromyography is evidence for a paradoxical sphincter reaction. Denervation was more pronounced in the external sphincter than in the puborectalis muscle. The right pudendal nerve was subjected to damage more often than the left nerve.

Adolescent↗
PubMed1992

Association between rectocele and paradoxical sphincter response.

Rectocele as well as paradoxical sphincter reaction may lead to rectal emptying difficulties and outlet obstruction. Forty-one patients with emptying disturbances and rectocele were investigated with defecography, anorectal manometry, colon transit time, and electromyography. Twenty-nine patients (71 percent) had concomitant paradoxical sphincter reaction, and 13 of these also had increased colon transit time. The functional results after surgical treatment of rectocele are not always satisfactory, probably because patients often have several causes for their emptying disturbances. It is emphasized that careful preoperative investigations are important before surgical treatment of rectocele in patients with emptying difficulties.

Adult↗