Play Video
1
Defecography Demonstrating a Sigmoidocele
Defecography Demonstrating a Sigmoidocele
::2011/04/06::
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2
Magnetic Resonance Defecography, Rectocele
Magnetic Resonance Defecography, Rectocele
::2013/06/17::
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3
Defecography showing Rectocele
Defecography showing Rectocele
::2013/09/19::
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4
Defecating In An MRI Scanner (Defecography)
Defecating In An MRI Scanner (Defecography)
::2013/05/25::
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5
Defecography showing Internal Rectal Prolapse
Defecography showing Internal Rectal Prolapse
::2013/09/19::
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6
MR Defecography, Proctogram: Enterocele, Cystocele, Rectocele
MR Defecography, Proctogram: Enterocele, Cystocele, Rectocele
::2013/06/19::
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7
Defecography showing Rectocele new
Defecography showing Rectocele new
::2014/09/24::
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8
Magnetic Resonance Defecography, Rectocele, Cystocele
Magnetic Resonance Defecography, Rectocele, Cystocele
::2013/06/14::
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9
Defecography showing Normal Defecation
Defecography showing Normal Defecation
::2014/02/05::
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10
Defecography or proctogram for constipation
Defecography or proctogram for constipation
::2013/05/17::
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11
Defecography showing Anterior Rectal Wall Prolapse new
Defecography showing Anterior Rectal Wall Prolapse new
::2014/09/24::
Play Video
12
Defecography showing Enterocele new
Defecography showing Enterocele new
::2014/09/24::
Play Video
13
Defecography showing Normal Defecation new
Defecography showing Normal Defecation new
::2014/09/24::
Play Video
14
Defecography showing Enterocele
Defecography showing Enterocele
::2014/02/05::
Play Video
15
Defecography showing Rectocele
Defecography showing Rectocele
::2014/12/09::
Play Video
16
Defecography showing Enterocele
Defecography showing Enterocele
::2014/12/09::
Play Video
17
Defecography showing Normal Defecation
Defecography showing Normal Defecation
::2014/12/09::
Play Video
18
Defecography showing Internal Rectal Prolapse
Defecography showing Internal Rectal Prolapse
::2014/12/09::
Play Video
19
Defecography showing Anterior Rectal Wall Prolapse
Defecography showing Anterior Rectal Wall Prolapse
::2014/12/09::
Play Video
20
Defecography showing Anterior Rectal Wall Prolapse
Defecography showing Anterior Rectal Wall Prolapse
::2014/02/05::
Play Video
21
Normal fluoroscopic (xray) defaecating proctogram
Normal fluoroscopic (xray) defaecating proctogram
::2014/03/17::
Play Video
22
How to Pronounce Defecography
How to Pronounce Defecography
::2013/04/29::
Play Video
23
Defecography showing Internal Rectal Prolapse new
Defecography showing Internal Rectal Prolapse new
::2014/09/24::
Play Video
24
Defecodome
Defecodome
::2010/12/13::
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25
Novel Combination of STAPLER Surgery & STARR Surgery  | Steve Myro | Healing Hands Clinic
Novel Combination of STAPLER Surgery & STARR Surgery | Steve Myro | Healing Hands Clinic
::2014/08/27::
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Lucky STARR for Constipation treatment
Lucky STARR for Constipation treatment
::2014/11/22::
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Male,Female STARR Surgery  in India | Healing Hands Clinic
Male,Female STARR Surgery in India | Healing Hands Clinic
::2013/10/04::
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Charter Radiology
Charter Radiology
::2014/10/10::
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STARR Surgery for Constipation
STARR Surgery for Constipation
::2014/07/17::
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Piles Surgery in Pune Testimonial | Piles Treatment Testimonial | Dr. Ashwin Porwal - Piles Doctor
Piles Surgery in Pune Testimonial | Piles Treatment Testimonial | Dr. Ashwin Porwal - Piles Doctor
::2013/12/05::
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ASHWIN JOSHI
ASHWIN JOSHI
::2012/07/19::
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Evacuated Enterocele "Moschcowitz Hernia"
Evacuated Enterocele "Moschcowitz Hernia"
::2013/11/09::
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BHIKURAM PAWAR
BHIKURAM PAWAR
::2012/07/19::
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Inauguration of New OT and Day Care Centre by Dr. John Murphy|Healing Hands Clinic
Inauguration of New OT and Day Care Centre by Dr. John Murphy|Healing Hands Clinic
::2014/12/03::
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Success Stories of Constipation Treatment in pune|Healing Hands Clinic
Success Stories of Constipation Treatment in pune|Healing Hands Clinic
::2014/11/29::
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Bawaseer ka ilaj | Bawaseer disease | Healing Hands Clinic
Bawaseer ka ilaj | Bawaseer disease | Healing Hands Clinic
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Dr Ashwin Porwal on ZEE TV on Modern treatment of Piles Constipation Fistula Prolapse Hernia Part- 1
Dr Ashwin Porwal on ZEE TV on Modern treatment of Piles Constipation Fistula Prolapse Hernia Part- 1
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Bawaseer Treatment in Hindi | Symptoms of bawaseer | HHC
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STAPLER Surgery for Piles | STAPLER Surgery in Pune | Healing Hands Clinic
STAPLER Surgery for Piles | STAPLER Surgery in Pune | Healing Hands Clinic
::2013/01/21::
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STARR Surgery Testimonial | Dr. Ashwin Porwal - Constipation Doctor in Pune
STARR Surgery Testimonial | Dr. Ashwin Porwal - Constipation Doctor in Pune
::2013/12/21::
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Hernia Surgeon in Pune | Hernia Surgery Video (3D) | Hernia Treatment | Healing Hands Clinic
Hernia Surgeon in Pune | Hernia Surgery Video (3D) | Hernia Treatment | Healing Hands Clinic
::2011/09/30::
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Dr Ashwin Porwal on ZEE TV on Modern treatment of Piles Constipation Fistula Prolapse Hernia Part- 2
Dr Ashwin Porwal on ZEE TV on Modern treatment of Piles Constipation Fistula Prolapse Hernia Part- 2
::2013/10/01::
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Mulvyadh Upchar |  Mulvyadh Treatment | Healing Hands Clinic
Mulvyadh Upchar | Mulvyadh Treatment | Healing Hands Clinic
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STARR Surgery for Constipation Video | Constipation Treatment in Pune | Healing Hands Clinic
STARR Surgery for Constipation Video | Constipation Treatment in Pune | Healing Hands Clinic
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Saam TV Dr Ashwin Porwal Mulakat Part-I
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Fecal Incontinence
Fecal Incontinence
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Testimonial for Piles treatment at Healing Hands Clinic | Dr. Ashwin Porwal - Piles Surgeon in Pune
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::2014/01/27::
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Hernia Surgery Video | Hernia Treatment in Pune | Hernia Doctor in Pune
Hernia Surgery Video | Hernia Treatment in Pune | Hernia Doctor in Pune
::2013/09/25::
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Piles and Fistula Treatment Testimonial | Dr. Ashwin Porwal - Piles Surgeon in Pune
Piles and Fistula Treatment Testimonial | Dr. Ashwin Porwal - Piles Surgeon in Pune
::2014/02/05::
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STARR Surgery in Pune |  STARR Surgery | Healing Hands Clinic Pune
STARR Surgery in Pune | STARR Surgery | Healing Hands Clinic Pune
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RESULTS [51 .. 101]
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Defecography
Diagnostics
Defecating proctogram of female showing rectocele.jpg
Example defecating proctogram of female showing anterior rectocele (white arrow), a possible cause of obstructed defecation and/or incomplete evacuation of stool
MeSH D019841

Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visualized in real time using a fluoroscope.[1] The anatomy and function of the anorectum and pelvic floor can be dynamically studied at various stages during defecation.[2]

History[edit]

Defecating proctography was pioneered in 1945, during World War II. The procedure gained popularity at this time in the midst of an outbreak of whipworm, which is known to cause rectal prolapse.[3] It has since become used for diagnosis of various anorectal disorders, including anismus and other causes of obstructed defecation.

It has fallen out of favor due to inadequate training in the technique. It is now only performed at a few institutions. Many radiology residents refer to the procedure as the "Def Proc", "Defogram", or "Stool Finale".[citation needed]

Indications[edit]

Defecography may be indicated for the following reasons:

Specifically, defecography can differentiate between anterior and posterior rectocele.[4] Also, in external rectal prolapse that was not directly visualized during examination, this radiographic projection will demonstrate its presence.

Technique[edit]

Caulk gun used for defecating proctogram

In females, pre-procedural preparation involves smearing a small amount of barium contrast in the vagina, which will help to identify if anterior rectocele, enterocele or sigmoidocele is present.

The technique itself involves insertion of a caulk gun device into the rectum with subsequent manual infusion of barium paste until there is adequate distension. The patient is then transferred to a portable plastic commode which is situated next to a fluoroscope which records the defecation. Positioning of the x-ray camera is of paramount importance as visualization of the buttocks, rectal vault, and lower pelvis is critical.

Diagnostic yield and interpretation[edit]

Anatomical and physiological parameters that can be objectively measured by this investigation include:[2]

Anorectal angle This is the "mid-axial longitudinal axis of the rectum and the anal canal", created by the anterior pull of the puborectalis sling at the level of the anorectal junction. At rest, it is held at 90 - 100°. This becomes more acute (70 - 90°) when the patient contracts the anal sphincters and pelvic floor muscles, and more obtuse (110 - 180°)during defecation.

Perineal descent This is "the caudad movement of the pelvic floor [during] straining". Defecation normally involves a relaxation of the pelvic floor (levator ani), leading to descent of the perineum. During straining, the opposite occurs, the perineum rises. From the proctogram, descent is calculated by drawing an imaginary line (the pubococcygeal line) between the most inferior point on the pubic bone and the tip of the coccyx. Normal perineal descent or elevation is less than 4 cm from the pubococcygeal line in either direction (superior or inferior).

Efficiency of emptying/evacuation Normally, there is 90-100% evacutaion of rectal contents.

Anal canal length This is measured during maximal evacuation.

Anal canal width Again measured during maximal evacuation, this is usually less than 2.5 cm.

Conditions which may be demonstrated include:[2]

  • Anismus (pelvic floor dysynergia)

It has been suggested that some patients may be embarrassed by this procedure, which give findings of abnormal defecation.[2] For example, the patient may not be able to relax under the conditions, leading to relaxation failure of puborectalis and false positive diagnosis of anismus. It has also been reported that there is a high false positive rate of anismus diagnosis with anorectal manometry for similar reasons.[5]

This is the most common finding with this type of imaging. Almost always, this is an anterior rectoceles where the anteiror rectal wall bulges forward, into the vagina in females. In males, the prostate gland gives more support in this area compared to the vaginal cavity, so rectoceles, especially anterior rectoceles are uncommon in males. Less commonly and in males, there may be posterior rectoceles, where the rectum bulges posteriorly. Both the size and the efficiency of emptying can be assessed with proctography. Since many rectoceles are asymptomatic, this may only be a significant finding if there are symptoms of obstructed defecation. Usually rectoceles greater than 3 cm and those that do not empty are clinically significant.

Enterocele is a prolapse of peritoneum that contains a section of small intestine. Sigmoidocele is a prolapse of peritoneum that contains a section of sigmoid colon. In females, these prolapses usually descend between the rectum and the vagina. They are most likely to be seen during straining.

The rectum may be seen to prolapse, whether internally or externally. There can be difficulty differentiating between internal intussusception and a normal rectal fold. The thickness of the intussusception is half the width of the intussusception (the intussusception is a doubled over layer of rectal wall). This is most likely to be seen during straining.

This is excessive width (>9 cm) of the rectum at the level of the distal sacrum and incomplete evacuation.

If the perineum descends >4 cm, descending perineum syndrome may be diagnosed.

If the barium paste does not stay in the rectum.

Cinedefecography and MRI defecography[edit]

Cinedefecography is a technique that is an evolution of defecagography. The defecation cycle is recorded as a continuous series rather than individual still radiographs.[2] More recent techniques involve the use of advanced, cross-sectional imaging modalities such as magnetic resonance imaging.[6] This is known as dynamic pelvic MRI, or MRI proctography.[2]The MRI proctography also called MRI defecography is not as efficient as conventional x-ray defecography for some problems.

See also[edit]

References[edit]

  1. ^ Defecating proctogram from Bristol Laparoscopic Surgery
  2. ^ a b c d e f g al.], senior editors, Bruce G. Wolff ... [et (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. pp. 47–52. ISBN 0-387-24846-3. 
  3. ^ ASCRS: Pelvic Floor Dysfunction
  4. ^ Wiersma, Tjeerd. "Dynamic rectal examination on the Radiology assistant". Retrieved 19 October 2012. 
  5. ^ Voderholzer, WA; Neuhaus, DA; Klauser, AG; Tzavella, K; Müller-Lissner, SA; Schindlbeck, NE (August 1997). "Paradoxical sphincter contraction is rarely indicative of anismus.". Gut 41 (2): 258–62. doi:10.1136/gut.41.2.258. PMC 1891465. PMID 9301508. 
  6. ^ MRI Defecating Proctogram

External links[edit]

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