Defecography

Defecography is a technique of examining the rectum and anal canal in which the patient is studied while sitting down rather than recumbent and recordings are obtained both at rest and during straining. The authors describe their findings in 83 patients with dyschezia. Defecation was normal in 28 patients. Prolapse of the anal mucosa was seen in 13 patients and internal procidentia in 23, 12 of whom also had intussusception manifested as rectal prolapse. A deep rectogenital fossa associated with an enterocele was seen in 16 patients; 13 had a proctocele, while fecal retention was seen in 5. Descent of the pelvic floor and changes in the angle between the rectum and anal canal were assessed. The authors recommend defecography as a more physiological means of assessing rectal dysfunction.     

Defecography commode

A mobile wooden commode was designed and built for use in defecography. The commode is made of 1/2-inch-thick plywood with birch veneer and a solid clear pine seat. Water or copper sheets are recommended for radiation filtration. A radiopaque ruler attached to the commode with a spring enables midline measurements. The modifications suggested by the authors have helped with setup and have improved the images acquired.     

排粪造影检查及其临床应用

本文介绍了排粪造影检查及划线测量方法，报告１７８例（１８５次）造影结果。其中对照组３６例，４例（１２．５％）有异常；排粪困难组１４２例，１０例（７．０４％）未见异常。报告了本地区（山东）肛直角和肛上距的正常测量值以及主要的异常Ｘ线表现；探讨了排粪造影检查对于肛管直肠部及盆底疾病的诊断应用价值。     

Defecography by spiral computed tomography

PURPOSE: We investigated the possible role of helical CT defecography in pelvic floor disorders by comparing our results with those of conventional defecography. MATERIAL AND METHODS: Our series consisted of 90 patients, namely 62 women and 28 men, ranging in age 24-82 years. They were all submitted to conventional defecography, and 18 questionable cases were also studied with helical CT defecography. The conventional examination was performed during the 4 standard phases of resting, squeezing, Valsalva and straining; we used a remote-control unit. The parameters for helical CT defecography were: 5 mm beam collimation, pitch 2, 120 KV, 250 mAs and 18-20 degrees gantry inclination to acquire coronal images of the pelvic floor. The rectal ampulla was distended with a bolus of 300 mL nonionic iodinated contrast agent (dilution: 3 g/cc). The patient wore a napkin and was seated on the table, except for those who could not hold the position and were thus examined supine. Twenty-second helical scans were performed at rest and during evacuation; multiplanar reconstructions were obtained especially on the sagittal plane for comparison with conventional defecographic images. RESULTS: An unquestionable diagnosis could be made in all the 18 patients submitted to helical CT defecography. The diagnosis was in agreement with proctology results and added new information in all cases. Sixteen patients had constipation and 2 fecal incontinence--one from rectal prolapse and the other from a rectovaginal fistula. In this latter case helical CT defecography permitted to confirm the fistula and suggest its course. One patient had a previously undetected ovarian cancer metastatic to the anterior rectal wall. DISCUSSION AND CONCLUSIONS: Coronal helical CT defecography images permitted to map the perineal floor muscles, while sagittal reconstructions provided information on the ampulla and the levator ani. To conclude, helical CT defecography performed well in the study of pelvic floor disorders and can follow conventional defecography especially in questionable cases.     

Defecography and treatment of essential anal pain

INTRODUCTION: Proctalgia is a chronic anal pain in the absence of any organic conditions of the anorectum and excluding such morphofunctional disorders as rectal prolapse, intussusception and solitary rectal ulcer, which are easily shown with defecography but not with other imaging techniques. Proctalgia patients undergo a long workup and many instrumental and radiologic examinations and are finally referred to the proctologist with a condition which is difficult to diagnose and treat. We investigated the defecographic findings and anorectal abnormalities of essential proctalgia, as well as the correlation between radiologic findings, clinical symptoms and efficacy of biofeedback treatment. MATERIALS AND METHODS: We retrospectively examined 31 patients (21 women and 10 men; age range: 25-67 years, mean: 46) with defecography, clinico-proctologic investigations integrated with anoscopy and sigmoidoscopy, anorectal manometry and psychological tests. The women were submitted to gynecologic examination: 8 patients had a history of anorectal and pelvic surgery. We did not perform anal electromyography because it may cause painful sphincterial spasms. All patients underwent 30-minute weekly sessions of biofeedback till regression of symptoms. RESULTS: Anal pain was described as anorectal in 18 cases, anoperineal in 7, anosphincterial in 5 and rectovaginal in 1 case. It radiated to the sacrum in 42% of cases, thighs in 23%, gluteus muscles in 19%, and was related to evacuation in 39% of cases. Pain lasted some hours (58%) to a few minutes (42%). Manometric data showed sphincterial hypertonia in 14 patients. Eleven patients suffered from anxiety and were on drug treatment. Defecography demonstrated rectocele in 15 cases, puborectalis muscle syndrome in 14, external sphincter spasm in 12, perineal descent in 8, rectal muscosal prolapse in 4, intussusception in 3 and fecal incontinence in 2 cases. After 10 weeks of biofeedback training, all patients reported improvement of symptoms, which was confirmed at manometry as reduced sphincterial pressure. CONCLUSIONS: The etiology of essential proctalgia is unknown, but functional disorders of the pelvic floor and sphincterial muscles, as well as altered perineal stasis and pudendal conditions, all play an important role. These data are confirmed in our study where puborectalis syndrome, external sphincterial spasm and perineal descent are involved in over 70% of cases. Defecography is a useful tool because it permits to diagnose abnormal anorectal morphology and to diagnose sphincterial and puborectalis muscle dysfunctions which are missed with other instrumental and imaging techniques.     

排粪造影对直肠子宫内膜异位症的诊断价值

直肠子宫内膜异位症(rectal endometriosis,RE)是指具有生长活力的子宫内膜累及直肠壁,在直肠壁内非癌性生长,受卵巢激素周期性影响,产生肛门坠胀、里急后重、经期便血等临床症状的疾病[1].排粪造影是在病人排粪时,对肛管直肠部及盆底进行静态、动态相结合的一种X线检查方法,能够显示部位的器质性病变和功能性异常.对直肠子宫内膜内异症的诊断有重要作用,并对临床的诊断和制订手术方案起指导作用.     

仿真排粪造影剂的研制及其临床应用研究

目的 :研制用于排粪造影的仿真排粪造影剂及配套用的注推器和专用软肛管 ,为临床提供诊断和治疗的依据。方法 :选择无便秘症状的健康志愿者 35例 (简称正常组 ) ,男 14例 ,女 2 1例 ,平均年龄 44岁。采用了钡悬液排粪造影检查 (简称 1法 )及仿真排粪造影检查 (简称 2法 )双法对比观察。便秘病人 6 7例 (简称便秘组 ) ,男 19例 ,女 48例 ,平均年龄 47岁。也进行了双法对比观察。 1法造影剂的配方为 2 0 0 %的硫酸钡悬液 40 0 ml。 2法配方 :包括硫酸钡粉剂、麦麸及白芨粉。结果 :正常组经 1法、2法观察 18例女性有轻度直肠前凸 ,占 5 1% ,余未见异常。1法、2法对比力排状态下肛直角有显著性差异。便秘组中 5例无异常发现 ,有异常发现的 6 2例病人中盆底痉挛异常者 2 3例 (简称痉挛组 ) ,占 34% ,其中男 10例 ,女 13例。盆底松驰异常者 39例 (简称松驰组 ) ,占5 8% ,其中男 5例 ,女 34例。痉挛组 :肛直角静息状态下 1法、2法测量结果相同 ,力排状态下不同。肛门上距静息状态下 1法、2法相同 ,力排状态下不同。松驰组 :肛直角静息状态下 1法、2法测量结果相同 ,力排状态下不同。肛门上距静息状态下 1法、2法相同 ,力排状态下相同。结论 :本造影方法可准确区别直肠粘膜脱垂和全套叠 ,正确诊断耻骨直肠肌痉挛     

直肠前突手术前后的动态X线和MR排粪造影

目的:评价动态X线和磁共振排粪造影在直肠前突自动痔疮套扎术(RPH)治疗前后的应用价值.方法:中重度直肠前突患者16例纳入研究,年龄25～68岁,平均51岁,均为经产妇;全部完成RPH术前和术后的动态X线和MRI排粪造影检查.在两种检查图像上分别分析直肠前突的程度和并发症,并进行对比分析.结果:X线排粪造影显示术前重度直肠前突10例(58％)和中度直肠前突6例(42％),术后仅见中度直肠前突2例;直肠前壁黏膜脱垂、直肠内套叠和痔疮的显示术后(3例次)明显少于术前(33例次)(x2=14.933,P＜0.001).MR排粪造影显示术前重度直肠前突7例(43％)和中度直肠前突9例(57％),术后仅显示中度直肠前突1例;结直肠并发症显示(13例次)明显少于X线排粪造影(42例次)(x2=15.291,P＜0.001),但显示了更多的结直肠外合并症.结论:X线和MRI排粪造影评价直肠前突各有优缺点,综合评价更完整,并对RPH治疗后评估有良好应用价值.     

结肠运输试验及排粪造影对便秘的诊断

目的：分析便秘的病因并评价结肠运输试验与排粪造影对便秘诊断的价值。材料与方法：对１００例便秘患者作结肠运输试验及排粪造影。结果：结肠运输异常者４３例，出口梗阻者９６例，两种均存在者占４２例，４２例中，外科单纯纠正出口梗阻３１例，术后随访发现１５例症状无明显改善且复查排粪造影均表现正常。结论：由于出口梗阻与结肠无力常合并存在并相互作用，作者强调；结肠运输试验与排粪造影联合应用将有助用于正确，全面的诊     

便秘的综合X线排粪造影

目的:探讨综合X线排粪造影检查对排便功能障碍(便秘)者的诊断价值.方法:137例便秘患者均完成结肠运输试验、逼囊试验和定量钡糊排粪造影或同步阴道造影(已婚女性)检查,并对检查结果进行分析.结果:便秘的原因是复杂的,结肠慢传输42例,功能性出口梗阻25例,逼囊试验不能逼出者87例.定量钡糊排粪造影或同步阴道造影显示大多数病例合并两种或两种以上异常.结论:便秘的X线综合排粪造影检查可以详细显示便秘相关病变,为临床治疗提供了可靠的依据.     

Defecography in rectal wall prolapse conditions]

INTRODUCTION: Pelvic floor and rectal prolapse conditions have greatly benefitted by new imaging and instrumental diagnostic approaches, and especially defecography, for both pathophysiological interpretation and differential diagnosis. We investigated the efficacy of defecography in the assessment of rectal prolapse, and in particular the role of videoproctography in diagnosing such dynamic disorders. MATERIAL AND METHODS: We selected 224 patients with rectal prolapse from a series of 1,190 consecutive subjects with evacuation disturbances examined in the last 5 years with defecography combined with videoproctography. The patients were 176 women and 48 men ranging in age 32-79 years (mean: 48). Defecography was carried out with Mahieu's technique, but we changed the filter position slightly. Sixty-seven per cent of our patients had been submitted to sigmoidoscopy, but this examination does not usually show rectal intussusception. Occult blood test in feces and double contrast barium enema were carried out in 42% and 38% of cases, respectively, to exclude any organic conditions of colon. RESULTS: Mucosal prolapse was more frequent than intussusception (71% and 34%, respectively); rectal walls went out through the anus in 12 cases of anorectal intussusception and thus caused external rectal prolapse. Rectal prolapse was associated with other anorectal alterations, such as rectocele, perineal descent and puborectalis muscle syndrome, in 96 cases. DISCUSSION AND CONCLUSIONS: The dynamic changes of ampulla are well depicted by videoproctography, which showed anorectum normalization and spontaneous reduction of invagination after intussusception. Defecography exhibited good capabilities in showing rectal wall function abnormalities. Finally, some features of videoproctography such as low radiation dose, noninvasiveness and ease of execution, make the examination acceptable to patients with anorectal disorders and for the follow-up of rectal prolapse.     

Defecography: techniques for improved image quality

Defecography is a radiographic study that demonstrates the physiological process involved when the rectum evacuates. Fluoroscopy, video recording and spot films are used to record the sequence of events that occur during defecation. Proper radiographic techniques and procedures must be used to demonstrate pathological conditions such as rectoceles, rectal intussusception and prolapse of the rectum.     

排粪造影对功能性出口梗阻便秘的诊断

目的　探讨排粪造影对功能性出口便秘的诊断价值。方法　对 5 0 0例功能性出口便秘患者进行排粪造影检查。女性 3 49例 ,男性 15 1例 ,年龄 14～ 78岁 ,平均 3 6.7岁。病史在 2个月～ 3 8年。主要临床症状 :排便困难、不适、腹痛、腹胀 ,排便时间延长 ,肛门坠胀及解不净 ,多数病人需长期服泻药及灌肠帮助排便。排粪造影是给病人灌入 40 0～ 60 0ml硫酸钡混悬液 ,病人侧坐在排便装置上 ,在X线电视下作动态观察、摄片。结果　通过对 5 0 0例患者排粪造影检查 ,发现有直肠前突 14 4例、直肠黏膜脱垂 75例、直肠内套叠 5 6例、盆底痉挛综合征 10 2例、耻骨直肠肌肥厚 65例、会阴下降 12 1例、正常 2 9例 ,以上症状多数由两种或两种以上同时出现。结论　排粪造影对功能性出口便秘的诊断具有重要价值。     

The barium-enema examination and rectal manometry in Hirschsprung disease.

Barium-enema studies and rectal manometry were clearly shown complementary in diagnosing Hirschsprung disease. Of 27 patients studied, 19 had positive barium-enema and rectal manometric studies and were proved histologically to have Hirschsprung disease. Three had positive barium-enemas but normal rectal manometric studies in the first 10 days of life; later manometric studies were positive, and all 3 were subsequently proved to have Hirschsprung disease. Three patients had negative barium-enema and positive manometric studies and were proved to have low segment Hirschsprung disease. If both studies indicate the disease, rectal biopsy is not necessary before surgery.     

动态排粪造影对直肠前突的诊断价值

目的：探讨动态采集法排粪造影对直肠前突的诊断价值。方法：回顾性分析469例出口梗阻型便秘患者的排粪造影资料。常规排粪造影52例,动态排粪造影373例,同时行常规和动态排粪造影44例。比较两种方法对直肠前突的显示率。结果：动态法发现直肠前突310例（轻度67例、中度178例、重度65例）,占74．34％（310／417）;常规法发现直肠前突59例（轻度29例、中度25例、重度5例）,占61．46％（59／96）;两种方法差异存在显著性意义（P〈0．05）。结论：动态排粪造影能提高直肠前突的显示率,并能观察和记录直肠前突深度的动态变化,提高诊断准确率。     

109例便秘患者的排粪造影分析

目的:通过便秘患者的排粪造影资料显示其肛管直肠形态及功能,寻找便秘原因.方法:109倒排粪造影,其中13例行结肠传输试验.结果:由于肛管直肠形态功能异常所致的排粪功能障碍者91例,其中女性病例占80.22%.而女性异常病例中又以直肠前突多见.排粪造影及结肠传输试验均异常者7例.外科单纯手术纠正者2例,术后随访造影表现正常.结论:排粪造影对于便秘患者病因分析及诊疗方案的制定有重要的意义.     

Computed tomography and anorectal malformations. Their postoperative evaluation

In spite of great progress in surgical treatment of anorectal malformations, fecal incontinence is still, in variable degrees, a frequent and unpleasant postsurgical sequela. The most frequent causes of incontinence are: i) the incorrect placement of the pulled-through colon in the levator ani and sphincteric muscular complex during abdominoperineal surgical procedures; ii) the poor development of sphincteric musculature; iii) the associated sacral anomalies. Postoperative CT helps to evaluate all the above-mentioned conditions, in view of possible new surgical procedure for improving continence (besides postoperative CT can help in choosing the more suitable surgical technique). Nine patients, aged 3 to 13 years, (2 with good continence and 7 with various degrees of incontinence), were studied with pelvic postoperative CT. In the cases (2) with good continence the CT picture was: good development of sphincteric musculature and neo-anorectum correctly placed into sphincteric musculature; in the cases (3) with low degree of continence: neoanorectum correctly placed, but hypoplastic puborectal muscle; in the cases (4) with complete incontinence, neoanorectum incorrectly placed and poor development of sphincteric musculature. A further posterior sagittal anorectoplasty (according Pe?a) is only suitable in the incontinence cases with: i) neoanorectum seriously misplaced; ii) good development of sphincteric musculature; iii) absence of sacral anomalies. Postoperative CT is a valid mean for demonstrating all the above-mentioned conditions and for choosing the best surgical technique in each case.     

Computed tomography and anorectal malformations. Their preoperative evaluation

The anatomical patterns of anorectal malformations have so far been studied according to the principles which inspire Pe?a's technique for the surgical treatment of anorectal anomalies. Thus, the diagnostic study of anorectal malformations has by the authors been considered a work of classification, but of identification. Among the diagnostic procedures in use in our Institute, preoperative CT of pelvis is performed to assess the presence and to define the development of muscular sphincteric structures towards prognostic evaluation of continence, the major long-term goal. Seven patients, aged 1-30 months, with anorectal anomalies were studied with preoperative CT of the pelvis. CT scans showed well-developed sphincteric muscles in 3 patients (2 with rectoureteral and 1 with rectovestibular fistulas), poorly developed muscular structures in 3 patients (with rectovaginal, cloacal and prostatic fistulas), absence of muscular structures in 1 case (with rectovesical fistula). CT findings were always confirmed at surgery, except for the case with rectovesical malformation where CT scans did not allow to identify the thin sphincteric musculature. The authors believe preoperative CT of the pelvis, together with other clinical and radiological examinations, to be a valid mean in the prognostic evaluation of continence.     

Endoluminal MR imaging of anorectal diseases.

Endoluminal magnetic resonance imaging (MRI) has become an important technique in the diagnostic work-up of patients with anorectal diseases. The high spatial resolution of endoluminal MRI gives a detailed demonstration of the anal and rectal anatomy and pathology. This technique has been demonstrated to be superior to endoluminal sonography and body coil MRI. Endoanal MRI and phased-array coil MRI seem to have comparable results in perianal fistulas, but comparative data are lacking. Phased-array coil MRI is the imaging technique of choice for imaging rectal tumors, while endoluminal MRI is the alternative technique for imaging rectal tumors and the preferred technique for imaging anal tumors. Endoluminal MRI is superior to phased-array coil MRI in fecal incontinence, as phased-array coil MRI does not give the detailed spatial resolution required for evaluation of anal sphincter lesions.