Defecating proctogram
| Defecating proctogram | |
|---|---|
| File: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 |
The defecating proctogram (also known as defecography, proctography or dynamic rectal examination) is a type of medical radiological imaging study 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
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 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".[citation needed]
Indications
Defecography may be indicated for the following reasons:
- Evaluation of rectal outlet obstruction (obstructed defecation) symptoms
- Suspected conditions such as internal rectal intussusception, enterocele, [[anismus], rectocele or sigmoidocele.
- To compare pre- and post-surgical repair of rectal outlet obstruction (obstructed defecation).[2]
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
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.
Diagnostic yield
Conditions which may be demonstrated include:[2]
- Anismus (pelvic floor dysynergia)
- Rectocele
- Enterocele
- Sigmoidocele
- Rectal Intussusception
- Megarectum
Anatomical and physiological parameters that can be objectively measured by this investigation include:[2]
- Anorectal angle
- Perineal descent
- Efficiency of emptying
- Anal canal length
Cinedefecography & MRI defecography
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.[5] This is known as dynamic pelvic MRI, or MRI proctography.[2]
References
- ^ Defecating proctogram from Bristol Laparoscopic Surgery
- ^ a b c d e f 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.
{{cite book}}:|first=has generic name (help)CS1 maint: multiple names: authors list (link) - ^ ASCRS: Pelvic Floor Dysfunction
- ^ Wiersma, Tjeerd. "Dynamic rectal examination on the Radiology assistant". Retrieved 19 October 2012.
- ^ MRI Defecating Proctogram
See also
External resources
- Dynamic rectal examination on "the Radiology Assistant", many example defecating proctograms with interpretation.