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At least 199 records · Page 11Linked to original sources
PubMed1997

Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse.

OBJECTIVE: Our purpose was to assess a modification of abdominal sacral colpopexy in 19 patients. STUDY DESIGN: The rectovaginal space was dissected to the superior aspect of the posterior vaginal fascia still contiguous with the perineal body. Mersilene (Ethicon, Somerville, N.J.) mesh was sutured to this fascia and along the entire posterior vaginal wall. Patients with vault prolapse, perineal descent, and associated rectoceles or enteroceles are reported. Outcome measures included bowel symptoms and pelvic organ prolapse staging. Defecography was performed in three patients. Wilcoxon signed rank analysis was used for comparison of prolapse measures. RESULTS: Mean follow-up was 11 weeks. Bowel symptoms improved in 8 of 11 women. No subjects had greater than stage II prolapse postoperatively and median improvement in stage was 3 (range 2 to 4). The mean decrease in the genital hiatus measurement was 3.13 +/- 1.25 (range 2 to 6) cm. Postoperative defecography documented correction of rectoceles and enteroceles and improvement in perineal descent with straining. CONCLUSIONS: Abdominal sacral colpoperineopexy is effective surgery for vaginal vault prolapse associated with perineal descent and posterior vaginal defects.

Adult↗
PubMed2001

Rectal prolapse in women with other defects of pelvic floor support.

OBJECTIVES: We describe a series of patients with rectal prolapse who had other pelvic floor defects. STUDY DESIGN: Patients with rectal prolapse that we examined between 1990 and 2000 were reviewed. RESULTS: During this time frame 55 patients with rectal prolapse were seen by one of us. Fifty-two of these patients had other defects of pelvic floor support and are the subject of this report. The diagnosis was established in all patients with video defecography. Thirty-nine of the patients had internal (occult) prolapse that simulated either a rectocele or an enterocele. The mean number of surgical procedures for pelvic floor support before the diagnosis of rectal prolapse was 1.5. Thirty-one patients underwent a sigmoid resection with rectopexy, 12 underwent a rectopexy alone, 3 underwent a Ripstein procedure, 2 elderly patients had physical therapy alone, and the other 4 patients had surgical correction of the rectal prolapse before being referred for repair of vaginal vault prolapse. Other procedures performed simultaneously included sacral colpopexy, sacrospinous suspension, rectopubic urethropexy, and abdominal fixation of the vagina to the uterosacral ligaments. CONCLUSIONS: Rectal prolapse frequently coexists with other pelvic floor defects. Internal rectal prolapse may simulate a rectocele or enterocele and requires defecography to establish the diagnosis. Rectopexy (with or without sigmoid resection) is a satisfactory technique for correction and may be combined with other reconstructive procedures on the pelvic floor.

Adult↗
PubMed2001

Anterior rectocele due to obstructed defecation relieved by botulinum toxin.

Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P =.0003). At the same time, rectocele depth (mean +/- SD) was reduced from 4.3 +/- 0.6 cm to 1.8 +/- 0.5 cm (P =.0000001) and rectocele area from 9.2 +/- 1.3 cm(2) to 2.8 +/- 1.6 cm(2) (P =.0000001). Anorectal manometry demonstrated decreased tone during straining from 70 +/- 28 mm Hg at baseline to 41 +/- 19 mm Hg at 1 month (P =.003) and to 41 +/- 22 mm Hg at 2 months (P =.005). No permanent complications were observed in any patient for a mean follow-up period of 18 +/- 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.

Adult↗
PubMed1998

Constipation assessed on the basis of colorectal physiology.

BACKGROUND: Constipation is a collective term for symptoms of different aetiologies and pathophysiologies. Our aim was to determine the prevalence of colorectal pathophysiology findings in a prospective series of patients with chronic constipation. METHODS: A total of 155 consecutive patients with chronic constipation underwent anorectal manometry, electromyography (EMG), the balloon expulsion test, colonic transit-time study, and defecography. RESULTS: All investigations were completed by 134 patients (112 females) with a median age 52 (range, 17-79) years. Patients were categorized on the basis of transit time and pelvic-floor function as belonging to 1 of 4 groups: slow-transit constipation (STC) (delayed transit time but normal pelvic-floor function, n = 28), pelvic-floor dysfunction (PFD) (pelvic-floor dysfunction and normal transit time, n = 32), combined slow transit and pelvic-floor dysfunction (STC + PFD) (n = 27), and normal-transit constipation (NTC) (normal transit time and normal pelvic-floor function, n = 47). There was no difference between diagnostic groups in anal sphincter pressures. However, rectal sensitivity to balloon distension was lower (P < 0.05) in patients with delayed transit. Paradoxical puborectalis contraction (PPC) was found on EMG in 42 patients (31%). The prevalence of PPC was higher (P < 0.001) in patients with pelvic-floor dysfunction. Inability to evacuate the rectal balloon was reported by 37% of patients with pelvic-floor dysfunction and 12% of patients with normal pelvic-floor function (P < 0.001). Rectocele was the only anatomic abnormality at defecography which was associated with poor rectal emptying. CONCLUSIONS: About two-thirds of our patients with constipation had objective evidence of delayed transit or pelvic-floor dysfunction. No single test could reliably identify any of the pathophysiologic subgroups of constipation.

Adult↗
PubMed2005

[Laparoscopic rectocele repair with mesh--a case report].

Relaxation of the pelvic floor causes changes in the anatomy. This results in symptoms, which can be treated with different operations. The use of modern, minimal invasive methods and tension free mesh implants for the reconstruction is widely used in rectocele repair as well. We present a 59 year-old patient undergone both vaginal hysterectomy and cystocele repair previously who complained of progressive constipation. Physical examination and dynamic defecography confirmed the presence of a significant rectocele. Anal manometry showed no functional loss. Mobilisation of the rectum and division of the recto-vaginal septum was performed laparoscopically followed by rectopexy and reinforcement of the septum by fixing polypropylene mesh in each position. There was no complication and recovery was fast. Control defecography and functional test one month later did not show pathological findings. One year after surgery the patient is free of complaints or recurrence. In selected patients both laparoscopic approach and mesh implants are safe.

Defecography↗
PubMedDate not supplied

MR imaging of the pelvic floor.

Pelvic floor disorders are a common clinical problem. Clinical evaluation frequently underestimates the extent of the disease. Fluoroscopic colpocystodefecography (CCD) is an established tool for diagnosing disorders of the rectum and recto- anal junction. It is however less performant when it comes to evaluate the complex pelvic floor mechanism in all its aspects. MR defecography allows to evaluate all the compartments of the pelvis without being invasive. This article describes the clinical setting, the MR technique and provides guidelines for interpretation of a MR defecography study.

Constipation↗
PubMed1989

Anorectal motility in children with complete rectal prolapse.

Anorectal manometry, defecography, and ultrasonographic study were performed in 36 children with complete rectal prolapse and 45 age- and sex-matched controls. Anorectal manometry disclosed that there was no significant difference in Pr, Pac, or length of HPZ between patients and controls. The rate of BRC of the smooth muscle of the anal canal and RC were significantly lower in patients. Rectoanal reflex was present in all patients and controls. Defecography and ultrasonographic examination confirmed the hypothesis that rectal prolapse starts initially as an intussusception of the rectum, then fully develops. In 29 cases patients were cured by conservative treatment, but seven patients required surgical treatment. Results of modified Sudeck's operation were, in general, satisfactory.

Adolescent↗
PubMed1996

Fecal incontinence successfully managed by antegrade continence enema in children: a report of two cases.

Two children with intractable fecal incontinence after correction of high anorectal malformations were successfully managed by the daily administration of a glycerin enema into the cecum via an appendicocecostomy or tubularized cecostomy, according to the method of Malone's antegrade continence enema (ACE). Fluoroscopic defecography performed during this procedure in each patient disclosed that the glycerin enema promptly evoked cecal peristalsis, which was transmitted to the distal colon and rectum, and squeezed out almost all the fecal matter, evacuating it from the anus. However, two enemas within a short interval were required to achieve a complete washout of feces. Although this report describes only two patients, our experience confirmed that the ACE was very effective and that adding the word "continence" to antegrade enema was justifiable. Moreover, fluoroscopic defecography was proven to play a significant role in determining the appropriate regimens of this technique to achieve complete washout of the feces.

Child↗
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↗
PubMed1996

Patterns of anismus and the relation to biofeedback therapy.

PURPOSE: A study was undertaken to assess physiologic characteristics and clinical significance of anismus. Specifically, we sought to assess patterns of anismus and the relation of these findings to the success of therapy. METHODS: Sixty-eight patients were found to have anismus based on history and diagnostic criteria including anismus by defecography and at least one of three additional tests: anorectal manometry, electromyography, or colonic transit time study. Interpretation of defecography was based on the consensus of at least three of four observers. Anal canal hypertonia (n = 32) was defined when mean and maximum resting pressures were at least 1 standard deviation higher than those in 63 controls. There were two distinct defecographic patterns of anismus: Type A (n = 26), a flattened anorectal angle without definitive puborectalis indentation but a closed anal canal; Type B (n = 42), a clear puborectalis indentation, narrow anorectal angle, and closed anal canal. Outcomes of 57 patients who had electromyographybased biofeedback therapy were reported as either improved or unimproved at a mean follow-up of 23.7 (range, 6-62) months. These two types of anismus were compared with biofeedback outcome to assess clinical relevance. RESULTS: Patients with Type A anismus showed greater perineal descent at rest (mean, 5.1 vs. 3.5 cm; P < 0.01), greater dynamic descent between rest and evacuation (mean, 2.7 vs. 1.4 cm; P < 0.01), greater difference of anorectal angle between rest and evacuation (mean, 14.6 vs. -3.1 degrees; P < 0.001), higher mean resting pressure (mean, 77.1 vs. 62.8 mmHg; P < 0.05), lower mean squeeze pressure (58.8 vs. 80.7 mmHg; P < 0.05), and a higher incidence of anal canal hypertonia (69.2 vs. 33.3 percent; P < 0.01) than did patients with Type B anismus. Only 25 percent of patients who had Type A anismus with anal canal hypertonia were improved by biofeedback therapy. Conversely, 86 percent of patients with Type B anismus without anal canal hypertonia were successfully treated with biofeedback (P < 0.001; Fisher's exact test). CONCLUSIONS: These two distinct physiologic patterns of anismus correlate with the success of biofeedback treatment. Therefore, knowledge of these patterns may help direct therapy.

Adolescent↗
PubMed1997

Treatment of puborectalis syndrome with progressive anal dilation.

PURPOSE: The aim of this study is to assess the ability of progressive anal dilations to improve frequency of spontaneous bowel movements in patients with puborectalis syndrome (PRS). METHOD: Thirteen patients (9 females and 4 males; mean age, 37 years) with severe, chronic constipation caused by PRS were treated with daily, progressive anal dilation for a three-month period. Three dilators of 20, 23, and 27 mm in diameter were used. Dilators were inserted every day for 30 minutes (10 minutes each dilator). Patients were evaluated with anorectal manometry and defecography halfway through treatment, at the end of treatment, and six months after the end of treatment. At six months, patients also underwent physical examination. RESULTS: There was a significant improvement of weekly mean spontaneous bowel movements from zero to six (P < 0.0001), and the need for laxatives decreased from 12 patients with a weekly mean of 4.6 to 2 patients once per week (P < 0.001). Enemas used before treatment by eight patients who had a weekly mean of 2.3 were, after treatment, needed only by three patients once per week (P < 0.01). During straining, tone measured with anorectal manometry decreased from 93 to 62 mmHg after six months of the end of therapy (F = 6.97; P < 0.01), and anorectal angle measured with defecography during the strain increased from 95 degrees to 110 degrees (P = not significant). CONCLUSIONS: Daily progressive anal dilation should be considered as the first and most simple therapeutic approach in patients with PRS.

Adolescent↗
PubMed1995

Internal rectal intussusception--fact or fancy?

PURPOSE: There is still considerable debate whether internal intussusception represents a functional disorder. We have reviewed our results in an effort to define its symptomatology and to assess defecography. METHODS: Rectopexy has been performed for internal intussusception in 37 patients. Eighteen had solitary rectal ulcer syndrome (SRUS), and 31 had anterior rectal wall prolapse. Defecography demonstrated anterior wall prolapse in 13, circular prolapse in 21, and no disorders in 3 patients. Pelvic floor function was normal. Follow-up varied from one to nine years. RESULTS: Twenty-six patients became asymptomatic. Anterior wall prolapses could not be palpated anymore. All SRUS lesions healed. Patients with SRUS (P < 0.001) or circular prolapse (P < 0.001) became significantly more asymptomatic. Results in patients with anterior rectal wall prolapse were significantly worse (P < 0.001). CONCLUSIONS: Internal intussusception is a distinct functional rectal disorder. Its symptomatology and findings during physical examination are aspecific. Characteristic defecographic features and presence of SRUS are indications for surgery, provided pelvic floor function during straining is normal.

Humans↗
PubMed1990

A combined electromyographic and cineradiologic investigation in patients with defecation disorders.

Records from 20 patients on whom defecography and electromyography were performed simultaneously because of defecation disorders were analyzed. According to the electromyographic investigation, the patients could be divided into three main groups: 1) normal sphincter reaction; 2) paradoxical sphincter reaction; and 3) combined reaction. Group A was characterized by a marked reduction of muscular activity during emptying and a pronounced closing reflex after emptying. This was followed by return of normal tonic activity. Patients in group B had no relaxation of the sphincters during emptying but a pronounced increased activity in the external sphincter and the puborectalis muscle. They also had severe emptying difficulties at defecography. No closing reflex was seen. In group C the electrical activity in the sphincters increased during moderate straining and when emptying was complete a clear closing reflex was seen. In this study, a dynamic visualization of the defecation together with a registration of electromyographic activity in the striated anal sphincters was performed. It was shown that patients with paradoxical sphincter reaction were lacking a closing reflex after emptying was complete. This has not been reported previously and is important evidence for the paradoxical defecation pattern. It was also shown that the patients with rectoceles had paradoxical sphincter reaction.

Adult↗
PubMed1999

Selection criteria for internal rectal prolapse repair by Delorme's transrectal excision.

PURPOSE: The aim of this study was to review our results of Delorme's transrectal excision for internal rectal prolapse, with a view to determining preoperative selection criteria associated with a satisfactory outcome. METHODS: Between 1992 and 1998, 20 patients with internal rectal prolapse underwent Delorme's transrectal excision. The last patient was excluded from the study because of a follow-up period shorter than six months. The remaining 19 patients were prospectively followed up and classified into two groups according to their preoperative selection criteria. Group I consisted of eight patients operated on between January 1992 and October 1993 who were selected for surgery after medical treatment during a three-month period failed to improve symptoms. Initial results were reviewed, with a follow-up of at least six months, to assess predictive criteria correlating with poorer surgical outcome. These adverse criteria were used to exclude patients from selection into Group II, which included 11 patients operated on between June 1994 and June 1997. In each group the degree of improvement of symptoms was graded: Grade 1 = complete improvement with resolution of all symptoms; Grade 2 = significant improvement with resolution of dyschezia but not of other symptoms; Grade 3 = no improvement; and Grade 4 = worsened condition or reoperation. The two groups were compared according to ultimate outcomes. RESULTS: Of the Group I patients, three had preoperative chronic diarrhea, one had proximal internal rectal prolapse with rectosacral separation at defecography, and the other two were incontinent to liquid stool. An additional patient had incontinence to liquid stool but no diarrhea. Three other patients had major perineal descent (>9 cm). Results were Grade 1 for one patient, Grade 2 for one patient, Grade 3 for five patients, and Grade 4 for one patient (subsequent abdominal rectopexy). Data review showed that proximal internal prolapse with rectosacral separation at defecography, preoperative chronic diarrhea, fecal incontinence, and descending perineum (>9 cm on straining) were associated with a poorer outcome (Grades 3 and 4). These adverse criteria were used to exclude patients from selection into Group II. In this group results were Grade 1 for seven patients and Grade 2 for four patients. During the course of follow-up (mean, 43; standard deviation, 19; range, 8-73 months), outcome was better in Group II (P = 0.007). CONCLUSION. These data suggest that a favorable outcome can be achieved after Delorme's transrectal excision for internal rectal prolapse by applying stringent patient-selection criteria.

Adult↗
PubMed1992

Internal rectal intussusception: results of surgical repair.

Twenty-four patients with obstructed defecation due to rectal intussusception diagnosed by defecography were treated with rectopexy either by the Wells technique (9 patients) or by Orr's operation (15 patients). After follow-up from one to eight years, defecography demonstrated disappearance of the intussusception in 22 patients. None of the patients were completely relieved of their symptoms. Nine (41 percent; 95 percent confidence limits: 21-64) were improved and 13 were unchanged (59 percent; 95 percent confidence limits: 36-79), with no difference between the two procedures. One patient with solitary rectal ulcer was improved, and the ulcer disappeared. Four patients with moderate preoperative incontinence became continent postoperatively, but obstructed defecation was only improved in two of these patients. It is concluded that rectal intussusception is probably a secondary phenomenon in patients with obstructed defecation and that a conservative attitude toward surgery should be adopted.

Adult↗
PubMed1999

Transsacral rectopexy for recurrent complete rectal prolapse.

The aim of this study was to examine the functional outcome of transsacral rectopexy performed with Dexon mesh for recurrent complete rectal prolapse. Anorectal function was assessed by anorectal manometry and defecography, before and from 1 year after surgery in five patients who were followed up for 1-3 years. The fecal incontinence score recovered from a preoperative mean score of 3.8 to a postoperative mean score of 1.2, and constipation was improved in four patients (80%). The straining anorectal angle (S-ARA), measured by defecography, improved from a preoperative value of 120.6 degrees +/- 6.9 degrees to a postoperative value of 98.5 degrees +/- 3.5 degrees (P < 0.05), and the perineal descent (PD) improved from a preoperative value of 16.2 +/- 2.5 cm to a postoperative value of 8.1 +/- 1.3 cm (P < 0.05). The maximal resting pressure (MRP) increased from a preoperative value of 20.5 +/- 3.7 cmH2O to a postoperative value of 40.5 +/- 4.8 cmH2O (P < 0.05). These findings indicate that transsacral rectopexy with Dexon mesh can achieve good control of recurrent complete rectal prolapse.

Aged↗
PubMed2005

Enterocele associated with rectocele revealed by dynamic pelvic CT.

Enterocele is often associated with other pelvic floor disorders but it is not always possible to detect by clinical examination. Defecography with peritoneography and/or barium meal intake has recently been developed as a new method to identify enterocele, but this method is an invasive procedure. Multislice computed tomography was performed at rest and during simulated defecation to evaluate an 80-year-old female patient who had a defecation disorder and was diagnosed as having rectocele based on results from defecography and clinical findings. Multiplanar reconstruction images were generated for image evaluation. Using this novel method of dynamic pelvic computed tomography, a third-degree enterocele was clearly demonstrated in this case.

Aged, 80 and over↗
PubMedDate not supplied

Restorative proctocolectomy: morphological and functional study with coronal CT.

BACKGROUND: Restorative proctocolectomy with ileal pouch has become the surgical treatment of choice for patients with ulcerative colitis (UC) and familial polyposis of the colon. Defecography is the radiological technique commonly employed to obtain detailed information on function and morphology of the ileal pouch; it allows the direct visualization of the ileal pouch and the anal canal, but it does not provide the visualization of the pelvis. METHODS: In all patients, computed tomography (CT) on coronal planes was performed to determine its possibilities as an alternative to defecography; 10 patients with UC submitted to restorative proctocolectomy and were examined. RESULTS: Coronal CT images provided a panoramic vision of the pelvis and demonstrated the morphology of the ileal pouch, the thickness of its walls, and its correlation with the surrounding tissues. Coronal CT also allowed the evaluation of the continence of ileo-anal and ileo-ileal anastomosis and the functional changes of the perineal muscles at rest and during squeezing. CONCLUSION: CT images acquired on coronal planes allows an easy and clear detection of the major postoperative complications, such as stenosis or dehiscences of the anastomosis, pelvic phlogosis, and fistulae.

Adenomatous Polyposis Coli↗