Defecating proctogram
 | This article needs attention from an expert in Medicine. Please add a reason or a talk parameter to this template to explain the issue with the article. (November 2011) |
 | This article needs additional citations for verification. (November 2011) |
| Defecating proctogram | |
|---|---|
| MeSH | D019841 |
The defecating proctogram or defecography is an imaging study performed by a radiologist in which the mechanics of a patient's defecation are visualized in real time using a fluoroscope.[1]
History
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.[2] It has since become the gold standard for diagnosis of any of a number of rectal contractile disorders, including anismus.[citation needed]
It has since 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".
Technique
In females, pre-procedural preparation involves smearing a small amount of barium contrast in the vagina while carefully avoiding the rectum. This can often prove to be somewhat challenging, depending on the physique of the individual.
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 flouroscope 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.
Cinedefography
This technique is an evolution of defecagography, where the defecation cycle is recorded as a continuous series.
Diagnostic yield
Conditions which may be demonstrated include:
- Anismus (pelvic floor dysynergia)
- Rectocele
- Enterocele
- Sigmoidocele
- Rectal Intussusception
- Megarectum
Anatomical and physiological parameters that can be objectively measured by this investigation include:
- Anorectal angle
- Perineal descent
- Efficiency of emptying
- Anal canal length
More recent techniques involve the use of advanced, cross-sectional imaging modalities such as magnetic resonance imaging.[3]
