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Magnetic Resonance Defecography, Rectocele
Magnetic Resonance Defecography, Rectocele
Published: 2013/06/17
Channel: Colorectal Surgery Services
Medical Video :  Defecography showing Rectocele
Medical Video : Defecography showing Rectocele
Published: 2015/02/22
Channel: Первый медицинский
Defecography Demonstrating a Sigmoidocele
Defecography Demonstrating a Sigmoidocele
Published: 2011/04/06
Channel: femalepelvicsurgery
Defecography, or evacuation proctography
Defecography, or evacuation proctography
Published: 2016/03/22
Channel: Lemmingski
Barium Enema Trigger
Barium Enema Trigger
Published: 2015/03/11
Channel: Evelyn Melero
Defecography in Pune, India - Healing Hands Clinic
Defecography in Pune, India - Healing Hands Clinic
Published: 2015/09/18
Channel: Dr. Ashwin Porwal
MR Defecography, Proctogram: Enterocele, Cystocele, Rectocele
MR Defecography, Proctogram: Enterocele, Cystocele, Rectocele
Published: 2013/06/19
Channel: Colorectal Surgery Services
Defecography or proctogram for constipation
Defecography or proctogram for constipation
Published: 2013/05/18
Channel: Colorectal Surgery Services
Hank Vann Defecating Proctogram Blues
Hank Vann Defecating Proctogram Blues
Published: 2014/07/08
Channel: Perry Costello
Defaecating proctogram showing rectal prolapse and enterocoele
Defaecating proctogram showing rectal prolapse and enterocoele
Published: 2014/01/21
Channel: Vikas Shah
Normal fluoroscopic (xray) defaecating proctogram
Normal fluoroscopic (xray) defaecating proctogram
Published: 2014/03/17
Channel: Vikas Shah
Constipation & Testing for Constipation
Constipation & Testing for Constipation
Published: 2013/01/16
Channel: Colorectal Surgery Services
Defaecating proctogram showing rectal prolapse 2
Defaecating proctogram showing rectal prolapse 2
Published: 2014/01/21
Channel: Vikas Shah
Barium Enema
Barium Enema
Published: 2012/04/24
Channel: Doktornarabote
Defaecating proctogram showing rectocoele and enterocoele
Defaecating proctogram showing rectocoele and enterocoele
Published: 2014/01/21
Channel: Vikas Shah
Medical vocabulary: What does Defecography mean
Medical vocabulary: What does Defecography mean
Published: 2016/01/19
Channel: botcaster inc. bot
Evacuated Enterocele "Moschcowitz Hernia"
Evacuated Enterocele "Moschcowitz Hernia"
Published: 2013/11/09
Channel: Defecography
Lucky STAPLED Transanal  Rectal Resection (STARR) Surgery for Constipation treatment
Lucky STAPLED Transanal Rectal Resection (STARR) Surgery for Constipation treatment
Published: 2014/11/22
Channel: Dr. Ashwin Porwal
Dynamic pelvic floor MRI (proctogram)
Dynamic pelvic floor MRI (proctogram)
Published: 2015/06/30
Channel: Vikas Shah
Defaecating proctogram showing rectal prolapse
Defaecating proctogram showing rectal prolapse
Published: 2013/11/28
Channel: Vikas Shah
Defaecating proctogram showing rectocoele
Defaecating proctogram showing rectocoele
Published: 2013/12/13
Channel: Vikas Shah
How to Pronounce Defecography
How to Pronounce Defecography
Published: 2013/04/30
Channel: Emma Saying
Magnetic Resonance Defecography, Rectocele, Cystocele
Magnetic Resonance Defecography, Rectocele, Cystocele
Published: 2013/06/14
Channel: Colorectal Surgery Services
Radiology Time-Out Procedures; Standardized Method for Time-Out -- Video Production
Radiology Time-Out Procedures; Standardized Method for Time-Out -- Video Production
Published: 2011/03/01
Channel: tcmultimedia
MRI defaecating proctogram
MRI defaecating proctogram
Published: 2013/11/28
Channel: Vikas Shah
Dynamic Proctography
Dynamic Proctography
Published: 2012/04/09
Channel: Ostomystory
Anorectal Manometry Testing Video
Anorectal Manometry Testing Video
Published: 2015/08/31
Channel: Brighter Health Network
ICPME1
ICPME1
Published: 2015/03/30
Channel: Rad Geek
STARR Surgery for Constipation
STARR Surgery for Constipation
Published: 2014/07/17
Channel: Dr. Ashwin Porwal
Male,Female STARR Surgery in India | Healing Hands Clinic
Male,Female STARR Surgery in India | Healing Hands Clinic
Published: 2017/02/03
Channel: Dr. Ashwin Porwal
Defecogram or Proctogram of Rectocele
Defecogram or Proctogram of Rectocele
Published: 2013/10/02
Channel: Colorectal Surgery Services
Defaecating proctogram showing anismus
Defaecating proctogram showing anismus
Published: 2014/01/21
Channel: Vikas Shah
Prolasso Rettale - Rettocele - Enterocele
Prolasso Rettale - Rettocele - Enterocele
Published: 2011/10/29
Channel: Adolfo Renzi
How to Pronounce Defecography
How to Pronounce Defecography
Published: 2016/12/10
Channel: Dictionary Voice
STARR Surgery for Rectal Prolapse by Dr Ashwin Porwal
STARR Surgery for Rectal Prolapse by Dr Ashwin Porwal
Published: 2016/03/12
Channel: Dr. Ashwin Porwal
Testimonial by Steve Myro after treatment of Piles and Constipation at Healing Hands Clinic
Testimonial by Steve Myro after treatment of Piles and Constipation at Healing Hands Clinic
Published: 2014/08/27
Channel: Dr. Ashwin Porwal
Chronic Constipation and Rectal Prolapse Testimonial Video
Chronic Constipation and Rectal Prolapse Testimonial Video
Published: 2015/02/11
Channel: Dr. Ashwin Porwal
Defecating Proctography - English
Defecating Proctography - English
Published: 2017/01/18
Channel: Dr Gary McKay - Colorectal Surgeons Sydney
Grade 1 rectocele MR defecogram
Grade 1 rectocele MR defecogram
Published: 2016/08/15
Channel: Nelly Tan
STARR Surgery for Constipation Video | Constipation Treatment in Pune | Healing Hands Clinic
STARR Surgery for Constipation Video | Constipation Treatment in Pune | Healing Hands Clinic
Published: 2013/01/21
Channel: Dr. Ashwin Porwal
MRI Defecating Proctogram
MRI Defecating Proctogram
Published: 2007/09/30
Channel: crazybuddhist
Defecodome
Defecodome
Published: 2010/12/14
Channel: axilla09
DEFECOGRAFIA NORMAL   F  M  28 8 03  3
DEFECOGRAFIA NORMAL F M 28 8 03 3
Published: 2010/09/03
Channel: lillipercy12
How to Pronounce Defecography
How to Pronounce Defecography
Published: 2015/03/03
Channel: Pronunciation Guide
Charter Radiology
Charter Radiology
Published: 2014/10/10
Channel: physiciandesigns
MR defecogram pelvic floor herniation with rectocele
MR defecogram pelvic floor herniation with rectocele
Published: 2016/08/15
Channel: Nelly Tan
MR evacuating proctography: example 1
MR evacuating proctography: example 1
Published: 2013/04/27
Channel: Darren Boone
Defecating Proctography - Korean
Defecating Proctography - Korean
Published: 2017/01/18
Channel: Dr Gary McKay - Colorectal Surgeons Sydney
dont you hate poopin?
dont you hate poopin?
Published: 2010/11/28
Channel: raebootetay
DEFECOGRAFIA, INVAGINACION   A Claro Vial
DEFECOGRAFIA, INVAGINACION A Claro Vial
Published: 2010/09/03
Channel: lillipercy12
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WIKIPEDIA ARTICLE

From Wikipedia, the free encyclopedia
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Defecography
Medical diagnostics
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 agent 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. After 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% evacuation 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 dyssynergia)

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. PMC 1891465Freely accessible. PMID 9301508. doi:10.1136/gut.41.2.258. 
  6. ^ MRI Defecating Proctogram

External links[edit]

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